Active NPI
Samuel Paul Brunson
- Dentist
- Fort Campbell, KY
National Provider Identifier
1477164655
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 9639
- Practice address
- 2441 21St St
Fort Campbell, KY 42223-5582 - Phone
- (270) 412-8545
- NPI assigned
- Aug 12, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 9639 | SC | Primary |
Addresses
Primary practice location
2441 21St St
Fort Campbell, KY 42223-5582
Mailing address
2441 21St St
Fort Campbell, KY 42223-5582
Phone (270) 412-8545
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9639 | SC | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1597190400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597190400000",
"number": "1477164655",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2441 21ST ST",
"city": "FORT CAMPBELL",
"state": "KY",
"postal_code": "422235582",
"telephone_number": "270-412-8545"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2441 21ST ST",
"city": "FORT CAMPBELL",
"state": "KY",
"postal_code": "422235582",
"telephone_number": "270-412-8545"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRUNSON",
"first_name": "SAMUEL",
"middle_name": "PAUL",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-08-12",
"last_updated": "2020-08-12",
"certification_date": "2020-08-12",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "SC",
"license": "9639",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Campbell, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.