Brunson, Connie Marie
Brunson, Connie Marie is an individual health care provider with primary practice located at 7777 Hennessy Blvd Ste 501B , Baton Rouge LA 70808-4300. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as her primary health care specialty. Brunson, Connie Marie can be contacted via phone (225) 765-3456.Contact Information
Primary practice address
7777 Hennessy Blvd Ste 501B
Baton Rouge LA 70808-4300
Phone: (225) 765-3456
Fax: (225) 765-1899
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Medical | 363AM0700X | PA.200104.RX | Louisiana |
Profile Details
| NPI number | 1841381647 |
|---|---|
| LBN Legal business name | Brunson, Connie Marie |
| Credentials | Physician Assistant (PA) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 27th, 2006 |
| Last updated | Jan 26th, 2021 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1841381647 | NPPES |
| Mississippi | MEDICAID | 08623701 | |
| Mississippi | MEDICAID | 1455261 |
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