Provider Demographics
NPI:1558434340
Name:BRYSON, CELESTINA DOROTHEA (APN)
Entity Type:Individual
Prefix:
First Name:CELESTINA
Middle Name:DOROTHEA
Last Name:BRYSON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17711 SAN FELIPE BAY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78255-3340
Mailing Address - Country:US
Mailing Address - Phone:501-765-5866
Mailing Address - Fax:
Practice Address - Street 1:17711 SAN FELIPE BAY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78255-3340
Practice Address - Country:US
Practice Address - Phone:501-765-5866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX665386363LA2100X, 364SA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
71604624206OtherQUALCHOICE
TX155388501Medicaid
5A150OtherBCBS
5A150Medicare PIN
5A150OtherBCBS
P57716Medicare UPIN