Provider Demographics
NPI:1972960706
Name:BRYNER, JAY JR (PA-C)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:BRYNER
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2270 HENDERSONVILLE RD STE 1
Mailing Address - Street 2:
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-2734
Mailing Address - Country:US
Mailing Address - Phone:828-222-4625
Mailing Address - Fax:828-333-5602
Practice Address - Street 1:2270 HENDERSONVILLE RD STE 1
Practice Address - Street 2:
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-2734
Practice Address - Country:US
Practice Address - Phone:828-222-4625
Practice Address - Fax:828-333-5602
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-25
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-06163363A00000X, 363AM0700X
NC0010061632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCN/AMedicaid
NCN/AMedicaid