| Doctor Name: | JOEL D BRUNSON |
| NPI Number: | 1043519705 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | APN |
| License Number: | APN0000015545 |
| Business Practice Address: | 209 Grace Cv Medina, TN - 383558785 |
| Business Phone Number: | 7317830400 |
| Business Fax Number: | 7317830402 |
| Mailing Address: | Po Box 100, MEDINA |
| State: | TN |
| Postal Code: | 383550100 |
| Phone Number: | 7317830400 |
| Fax Number: | 7317830402 |
| NPI Enumeration Date: | 03/21/2011 |
| NPI Last Update Date: | 01/29/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | APN0000015545 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |