Healthcare Provider Details

I. General information

NPI: 1518959444
Provider Name (Legal Business Name): KIMBERLY COKER BRUNSTING NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 09/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2375 CHAMPIONS BLVD 3RD FLOOR
AUBURN AL
36830-6471
US

IV. Provider business mailing address

2375 CHAMPIONS BLVD 3RD FLOOR
AUBURN AL
36830-6471
US

V. Phone/Fax

Practice location:
  • Phone: 334-528-5959
  • Fax: 334-528-5899
Mailing address:
  • Phone: 334-528-5959
  • Fax: 334-528-5899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-078166
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: