Provider Demographics
NPI:1851983886
Name:BRISSON, JOHN A (PA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:BRISSON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1460 N 16TH AVE STE D
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-7102
Mailing Address - Country:US
Mailing Address - Phone:509-574-3805
Mailing Address - Fax:509-576-7620
Practice Address - Street 1:1460 N 16TH AVE STE D
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-7102
Practice Address - Country:US
Practice Address - Phone:509-574-3805
Practice Address - Fax:509-576-7620
Is Sole Proprietor?:No
Enumeration Date:2021-02-10
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9114002363A00000X
WAPABP.BG.61267147363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant