Provider Demographics
NPI:1245792399
Name:WADDINGTON, BRYNN BABETTE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:BRYNN
Middle Name:BABETTE
Last Name:WADDINGTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:BRYNN
Other - Middle Name:BABETTE
Other - Last Name:DOUGLAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2524 LA COSTA AVE
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-7321
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2524 LA COSTA AVE
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-7321
Practice Address - Country:US
Practice Address - Phone:855-409-1948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-05
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57460363A00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program