Provider Demographics
NPI:1518706365
Name:BRYAN, AMY BROOKE (REEGT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:BROOKE
Last Name:BRYAN
Suffix:
Gender:F
Credentials:REEGT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7814 SUNSET COVE DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-4454
Mailing Address - Country:US
Mailing Address - Phone:210-787-7135
Mailing Address - Fax:
Practice Address - Street 1:7814 SUNSET COVE DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-4454
Practice Address - Country:US
Practice Address - Phone:210-787-7135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX52962472E0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2472E0500XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherEEG