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DR. BRUNDA REVANNA M.D. NPI 1689646135


NPI Information

NPI: 1689646135
Provider Name: DR. BRUNDA REVANNA, M.D.
Classification: Family Medicine - 207Q00000X
Entity Type: Individual

PECOS Registration: Yes

Address:
1465A 1ST AVE SW STE A
JACKSONVILLE, AL
ZIP 36265
Phone: (256) 435-8383
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DR. Brunda Revanna, M.D. is a family medicine in Jacksonville, AL with 21 years of experience. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. DR. Brunda Revanna, M.D. NPI is 1689646135. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

Education
Medical School: MERCER UNIVERSITY SCHOOL OF MEDICINE
Graduation Year:2003

The provider's business location address is:

1465A 1ST AVE SW STE A
JACKSONVILLE, AL
ZIP 36265
Phone: (256) 435-8383

The NPI 1689646135 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 2/7/2006 and was last updated on 6/15/2015.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207Q00000XFamily Medicine00025426ALABAMAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1009930945MEDICAIDALABAMA
2051517109MEDICARE ID-TYPE UNSPECIFIEDALABAMA
3051517109OTHERAL BCBS
4270060909OTHERTRICARE
5H3509MEDICARE UPINALABAMA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.