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General NPI Number Information
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NPI Number | 1699058354
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Entity Type | Organization
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Legal Business Name | QUALITY CARE CENTER
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Dates
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Enumeration Date | 09/20/2011
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Last Update Date | 09/20/2011
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Provider Practice Location Address
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Address Line | 103 WATTS ST
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City | JONESBORO
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State | LA
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Zip | 71251-2053
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Country | US
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Telephone | 318-259-1511
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Fax | 318-259-9979
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Provider Business Mailing Address
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Address Line | 103 WATTS ST
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City | JONESBORO
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State | LA
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Zip | 71251-2053
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Country | US
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Telephone | 318-259-1511
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Fax | 318-259-9979
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Authorized Official
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Title or Position | FAMILY NURSE PRACTITIONER
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Name | MRS. KIMBERLY LYNN BRUNSON
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Credential | FNP
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Telephone | 318-259-1511
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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 | AP05919
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License Number State | LA
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