Provider Demographics
NPI:1700669462
Name:LUEDECKE, BRYAN REID (PHMNP-BC- MSN, RN)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:REID
Last Name:LUEDECKE
Suffix:
Gender:M
Credentials:PHMNP-BC- MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:12800 HARRISGLENN DR APT 1212
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-5336
Mailing Address - Country:US
Mailing Address - Phone:361-782-9060
Mailing Address - Fax:
Practice Address - Street 1:8334 CROSS PARK DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78754-5122
Practice Address - Country:US
Practice Address - Phone:512-323-2622
Practice Address - Fax:512-323-2625
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1131904363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health