CONNIE MARIE BRUNSON PA NPI 1841381647

NPI Information

NPI: 1841381647
Provider Name: CONNIE MARIE BRUNSON, PA
Classification: Physician Assistant - 363AM0700X
Entity Type: Individual

Specialization: Medical

Organization: OUR LADY OF THE LAKE PHYSICIAN GROUP LLC

PECOS Registration: Yes

Address:
7777 HENNESSY BLVD STE 501B
BATON ROUGE, LA
ZIP 70808
Phone: (225) 765-3456
Get Directions

Connie Marie Brunson, PA is a medical physician assistant in Baton Rouge, LA with 18 years of experience. Connie Marie Brunson, PA NPI is 1841381647. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

7777 HENNESSY BLVD STE 501B
BATON ROUGE, LA
ZIP 70808-300
Phone: (225) 765-3456
Fax: (225) 765-1899

The NPI 1841381647 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 9/27/2006 and was last updated on 1/26/2021.

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 Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363AM0700X	Physician Assistant	Medical	PA.200104.RX	LOUISIANA	Yes

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 Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	08623701	MEDICAID	MISSISSIPPI
2	1455261	MEDICAID	LOUISIANA

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: 11/14/2023

NPI Synchronization or Removal

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