Healthcare Provider Details

I. General information

NPI: 1477785798
Provider Name (Legal Business Name): KIMBERLY G. BRUNSON APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2009
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 BOND ST
JONESBORO LA
71251-5334
US

IV. Provider business mailing address

PO BOX 70
HODGE LA
71247-0070
US

V. Phone/Fax

Practice location:
  • Phone: 318-259-1100
  • Fax: 318-259-1333
Mailing address:
  • Phone: 318-259-1100
  • Fax: 318-259-1333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number107826-05919
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-185698
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: