Provider Demographics
NPI:1891749263
Name:DANIELS, BRYAN K (CRNA)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:K
Last Name:DANIELS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3004 TROON RD
Mailing Address - Street 2:
Mailing Address - City:ENNIS
Mailing Address - State:TX
Mailing Address - Zip Code:75119-7267
Mailing Address - Country:US
Mailing Address - Phone:972-875-2266
Mailing Address - Fax:
Practice Address - Street 1:2201 W LAMPASAS ST
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119-5644
Practice Address - Country:US
Practice Address - Phone:972-875-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX598247367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY74003617Medicaid
KY000000383673OtherANTHEM BCBS KY
KYC20338OtherCUMBERLAND HEALTHCARE
TX109961605Medicaid
KY74003617Medicaid
TX109961605Medicaid