Provider Demographics
NPI:1760707186
Name:BIXBY, BRYNN MARIE (MPAC)
Entity Type:Individual
Prefix:
First Name:BRYNN
Middle Name:MARIE
Last Name:BIXBY
Suffix:
Gender:F
Credentials:MPAC
Other - Prefix:
Other - First Name:BRYNN
Other - Middle Name:MARIE
Other - Last Name:MEREDITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1207 2ND ST W
Mailing Address - Street 2:
Mailing Address - City:ROUNDUP
Mailing Address - State:MT
Mailing Address - Zip Code:59072-1835
Mailing Address - Country:US
Mailing Address - Phone:406-323-3337
Mailing Address - Fax:
Practice Address - Street 1:1207 2ND ST W
Practice Address - Street 2:
Practice Address - City:ROUNDUP
Practice Address - State:MT
Practice Address - Zip Code:59072-1835
Practice Address - Country:US
Practice Address - Phone:406-323-3337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT608363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant