Provider Demographics
NPI:1922638394
Name:EYERMAN, BRYN AVERY
Entity Type:Individual
Prefix:
First Name:BRYN
Middle Name:AVERY
Last Name:EYERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 S SOUTH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-4589
Mailing Address - Country:US
Mailing Address - Phone:336-786-6277
Mailing Address - Fax:
Practice Address - Street 1:708 S SOUTH ST STE 100
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-4589
Practice Address - Country:US
Practice Address - Phone:336-786-6277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-24
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-09741363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant