Healthcare Provider Details

I. General information

NPI: 1306411848
Provider Name (Legal Business Name): JOY BRUNER FNP-C, MSN, ASN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2021
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 MEMORIAL DR
DALTON GA
30720-2529
US

IV. Provider business mailing address

1200 MEMORIAL DR
DALTON GA
30720-2529
US

V. Phone/Fax

Practice location:
  • Phone: 706-272-6158
  • Fax:
Mailing address:
  • Phone: 706-272-6158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number142924
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP146557
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: