Provider Demographics
NPI:1578564746
Name:ALLEN, BRYAN E (RN, BSN-FNP)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:E
Last Name:ALLEN
Suffix:
Gender:M
Credentials:RN, BSN-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4304 ANDREWS HWY
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79703-4824
Mailing Address - Country:US
Mailing Address - Phone:432-520-3020
Mailing Address - Fax:432-699-1981
Practice Address - Street 1:4304 ANDREWS HWY
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79703-4824
Practice Address - Country:US
Practice Address - Phone:432-520-3020
Practice Address - Fax:432-699-1981
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2020-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX624626363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX325374201Medicaid
TX8763NFOtherBCBS
TXP01290248OtherMEDICARE RR
TXP01290248OtherMEDICARE RR
TX8763NFOtherBCBS
TXP55250Medicare UPIN