Provider Demographics
NPI:1508682246
Name:WERRY, BRYAN ROBERTS (PMHNP)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:ROBERTS
Last Name:WERRY
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 86
Mailing Address - Street 2:
Mailing Address - City:VERADALE
Mailing Address - State:WA
Mailing Address - Zip Code:99037-0086
Mailing Address - Country:US
Mailing Address - Phone:509-655-2565
Mailing Address - Fax:
Practice Address - Street 1:201 W NORTH RIVER DR STE 301
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2262
Practice Address - Country:US
Practice Address - Phone:509-903-0103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61628939363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health