Provider Demographics
NPI:1447404181
Name:BRYDON, KAREN RICE (PHD, RNC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:RICE
Last Name:BRYDON
Suffix:
Gender:F
Credentials:PHD, RNC
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:RICE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, RNC
Mailing Address - Street 1:3107 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-6718
Mailing Address - Country:US
Mailing Address - Phone:210-832-8031
Mailing Address - Fax:
Practice Address - Street 1:3107 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-6718
Practice Address - Country:US
Practice Address - Phone:210-832-8031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-07
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX649614305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX649614OtherPRIVATE INSURANCE