MEDICARE: JENNIFER NICOLE BRUNER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	8803	AR

General Provider Information

NPI Number	:	1205712759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER NICOLE BRUNER

Provider Business Mailing Address
First Line	:	28049 HIGHWAY 295
Second Line	:
City	:	WESLEY
State	:	AR
Zip	:	72773-8700
Country	:	US
Telephone Number	:	479-236-6434
Fax Number	:

Provider Business Practice Location Address
First Line	:	2863 N OLD MISSOURI RD STE 112C
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72703-3777
Country	:	US
Telephone Number	:	479-301-0507
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2025
Last Update Date	:	08/12/2025

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Directions to “ JENNIFER NICOLE BRUNER ” Practice Location

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