MEDICARE: MRS. LANA CLIETT BRUNETT APRN, FNP, PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	658403	TX
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	658403	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	05546	OTHER	TX	PRESCRIPTION ID NUMBER

General Provider Information

NPI Number	:	1982825550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LANA CLIETT BRUNETT APRN, FNP, PMHNP

Provider Business Mailing Address
First Line	:	471 FM 3370
Second Line	:
City	:	AQUILLA
State	:	TX
Zip	:	76622
Country	:	US
Telephone Number	:	254-695-7896
Fax Number	:

Provider Business Practice Location Address
First Line	:	3501 N 19TH ST
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76708-2097
Country	:	US
Telephone Number	:	254-745-5117
Fax Number	:	254-296-5935

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	05/02/2024

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