Provider Demographics
NPI:1164475265
Name:KRYSL, BRADLEY DANIEL (CRNA)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:DANIEL
Last Name:KRYSL
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 840853
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0853
Mailing Address - Country:US
Mailing Address - Phone:972-233-1999
Mailing Address - Fax:972-233-3666
Practice Address - Street 1:12222 MERIT DR STE 600
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-3294
Practice Address - Country:US
Practice Address - Phone:972-715-5000
Practice Address - Fax:972-715-9976
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX733515367500000X
TXAP113742367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8326UGOtherBCBS TX
TX84770UOtherBCBS OF TEXAS
TX173961704Medicaid
TX89476UOtherBLUE CROSS BLUE SHEILD
TX173960706Medicaid
TXP00809363OtherRAILROAD
TX173961707Medicaid
TX89476UOtherBCBS
TX173960706Medicaid
TX8L2130Medicare PIN
TX8326UGOtherBCBS TX