Provider Demographics
NPI:1699058354
Name:QUALITY CARE CENTER
Entity type:Organization
Organization Name:QUALITY CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BRUNSON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:318-259-1511
Mailing Address - Street 1:103 WATTS ST
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:LA
Mailing Address - Zip Code:71251-2053
Mailing Address - Country:US
Mailing Address - Phone:318-259-1511
Mailing Address - Fax:318-259-9979
Practice Address - Street 1:103 WATTS ST
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:LA
Practice Address - Zip Code:71251-2053
Practice Address - Country:US
Practice Address - Phone:318-259-1511
Practice Address - Fax:318-259-9979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP05919363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1807192Medicaid
LA1054453Medicaid