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General NPI Number Information
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NPI Number | 1548998750
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Entity Type | Individual
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Provider Name | KRISTEN MARIE BRUNETTIN NP
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Gender | Female
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Dates
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Enumeration Date | 08/15/2022
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Last Update Date | 07/23/2024
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Provider Practice Location Address
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Address Line | 787 WEATHERLY DR STE 400
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City | CLARKSVILLE
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State | TN
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Zip | 37043-8952
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Country | US
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Telephone | 931-291-9150
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Fax |
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Provider Business Mailing Address
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Address Line | 3024 BUSINESS PARK CIR
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City | GOODLETTSVILLE
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State | TN
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Zip | 37072-3132
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Country | US
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Telephone | 615-239-2018
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Fax |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN147800
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 229177
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 36268
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License Number State | TN
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