Provider Demographics
NPI:1659141174
Name:BRYSON, KRISTA JUNE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:JUNE
Last Name:BRYSON
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:
Other - Last Name:VAN DYK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:84 OHIO ST STE 8
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-1806
Mailing Address - Country:US
Mailing Address - Phone:064-646-2470
Mailing Address - Fax:406-299-3911
Practice Address - Street 1:84 OHIO ST
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-1806
Practice Address - Country:US
Practice Address - Phone:406-646-2470
Practice Address - Fax:406-299-3911
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-05
Last Update Date:2024-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-APRN-LIC-233853363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty