Provider Demographics
NPI:1073551651
Name:BRYSON, BARBARA L (FNP)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:L
Last Name:BRYSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2073 OLYMPIC STREET
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-3413
Mailing Address - Country:US
Mailing Address - Phone:451-682-3550
Mailing Address - Fax:451-682-3551
Practice Address - Street 1:2073 OLYMPIC STREET
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-3413
Practice Address - Country:US
Practice Address - Phone:451-682-3550
Practice Address - Fax:451-682-3551
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR085074655N1-FNP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR239296Medicaid
ORP23435Medicare UPIN
OR108524Medicare ID - Type Unspecified