Brandi Bruner
Individual provider Active NPI Psychologist · Riverton, KS
NPI 1548627136 · NPPES record last updated Jul 7, 2016
Key facts
- NPI
- 1548627136
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- License
- T-LMLP 2681 (KS)
- Practice address
- 6610 SE Quakervale Rd
Riverton, KS 66770-4185 - Phone
- (620) 848-2300
- NPI assigned
- Jan 27, 2016
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Mental Health Counselor
- Education
- Other, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- College Skyline Center LLC
Practice addresses (Care Compare)
1230 N Duquesne Rd
Joplin, MO 64801-1509
Phone (417) 782-1443
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231220000280 | MO | Practitioner - Mental Health Counselor | 5395195192 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| T-LMLP 2681 | KS | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| College Skyline Center LLC | Current |
Accepting new patients |
Locations
1230 N Duquesne Rd
Joplin, MO 64801
Phone (417) 782-1443
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | T-LMLP 2681 | KS | Yes |
Addresses
Primary practice location
6610 SE Quakervale Rd
Riverton, KS 66770-4185
Mailing address
PO Box 550
Riverton, KS 66770-0550
Other providers in Riverton, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 7, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.