Provider Demographics
NPI:1700643392
Name:ROBERSON, BRYANT (APRN-CNP)
Entity Type:Individual
Prefix:MR
First Name:BRYANT
Middle Name:
Last Name:ROBERSON
Suffix:
Gender:M
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 SUMMER POINTE DR
Mailing Address - Street 2:
Mailing Address - City:BUDA
Mailing Address - State:TX
Mailing Address - Zip Code:78610-5909
Mailing Address - Country:US
Mailing Address - Phone:512-420-6789
Mailing Address - Fax:
Practice Address - Street 1:1010 RANCH ROAD 620 S STE 107
Practice Address - Street 2:
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734-5638
Practice Address - Country:US
Practice Address - Phone:512-960-2165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1076152363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care