Provider Demographics
NPI:1649043795
Name:FERRELL, BRYAN
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:FERRELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1428 2ND AVE N
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-4119
Mailing Address - Country:US
Mailing Address - Phone:515-574-6110
Mailing Address - Fax:515-573-3908
Practice Address - Street 1:1428 2ND AVE N
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-4119
Practice Address - Country:US
Practice Address - Phone:515-574-6110
Practice Address - Fax:515-573-3908
Is Sole Proprietor?:No
Enumeration Date:2023-10-31
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA164170163W00000X
IAA177932363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse