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General NPI Number Information
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NPI Number | 1497812192
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Entity Type | Individual
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Provider Name | KERRY GAYLE BRUNER APN,FNP, BC
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Gender | Female
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 2602 SAINT MICHAEL DR STE 400
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City | TEXARKANA
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State | TX
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Zip | 75503-5224
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Country | US
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Telephone | 903-794-0888
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 301
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City | TEXARKANA
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State | TX
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Zip | 75504-0301
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Country | US
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Telephone | 903-793-0122
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Fax | 903-792-7630
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP111717
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License Number State | TX
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