Healthcare Provider Details

I. General information

NPI: 1699181792
Provider Name (Legal Business Name): KEVIN TODD BRUNACINI DNP, APRN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2014
Last Update Date: 09/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6267 FINCHLEY RD
INDEPENDENCE KY
41051-8591
US

IV. Provider business mailing address

6267 FINCHLEY RD
INDEPENDENCE KY
41051-8591
US

V. Phone/Fax

Practice location:
  • Phone: 937-205-6529
  • Fax:
Mailing address:
  • Phone: 937-205-6529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3008539
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: