Individual provider Active NPI

Pamela Clover Brunson, ARNP

  • Family Nurse Practitioner
  • Lexington, TN
National Provider Identifier
1013345529
Registry record updated Dec 8, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
ARNP 9203441 Issued in FL
Practice address
16570 Highway 104 N
Ste B
Lexington, TN 38351-3877
Phone
(731) 968-2233
NPI assigned
Oct 18, 2013
Last updated
Dec 8, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X ARNP 9203441 FL Primary

Addresses

Primary practice location

16570 Highway 104 N
Ste B
Lexington, TN 38351-3877

Mailing address

16570 Highway 104 N
Ste B
Lexington, TN 38351-3877
Phone (731) 968-2233

Other identifiers 1

IdentifierTypeStateIssuer
009904700MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, TN2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20131125000501 FL Practitioner - Nurse Practitioner 3870729759 Reassigns benefits to 1 organization
Practice locations: Ormond Beach, FL
I20160105001322 TN Practitioner - Nurse Practitioner 3870729759 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
19418TNMDHospitalist Physician
ARNP 9203441FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Ricardo J. Larrain M.D., P.a. CurrentSince Feb 1, 2014 Accepting new patients
Curana Health of Tennessee LLC Family CurrentSince Dec 7, 2015 Accepting new patients

Locations

800 W Plymouth Ave
Deland, FL 32720
Phone (386) 736-1404

1414 W Granada Blvd
Ste 3
Ormond Beach, FL 32174
Phone (386) 258-0401

1509 Dulles Dr
Lafayette, LA 70506
Phone (337) 408-0803

5865 Ridgeway Center Pkwy
Memphis, TN 38120
Phone (901) 210-1010

Interoperability endpoints

  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1382054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481155200000",
    "number": "1013345529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16570 HIGHWAY 104 N",
            "address_2": "STE B",
            "city": "LEXINGTON",
            "state": "TN",
            "postal_code": "383513877",
            "telephone_number": "731-968-2233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16570 HIGHWAY 104 N",
            "address_2": "STE B",
            "city": "LEXINGTON",
            "state": "TN",
            "postal_code": "383513877",
            "telephone_number": "731-968-2233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUNSON",
        "first_name": "PAMELA",
        "middle_name": "CLOVER",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-10-18",
        "last_updated": "2016-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "ARNP 9203441",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009904700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lexington, TN

Sources for this page

Verify at the official NPI Registry.