Healthcare Provider Details

I. General information

NPI: 1255269155
Provider Name (Legal Business Name): DIANE LYNN BRUNET
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13131 HIGHWAY 603 STE 102
BAY ST LOUIS MS
39520-8746
US

IV. Provider business mailing address

1867 CRANE RIDGE DR STE 150C
JACKSON MS
39216-4982
US

V. Phone/Fax

Practice location:
  • Phone: 228-466-4690
  • Fax:
Mailing address:
  • Phone: 228-466-4690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: