Provider Demographics
NPI:1740851633
Name:BUMPAS, BRYN ELISE
Entity type:Individual
Prefix:
First Name:BRYN
Middle Name:ELISE
Last Name:BUMPAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRYN
Other - Middle Name:ELISE
Other - Last Name:JENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8210 WALNUT HILL LN STE 130
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4418
Mailing Address - Country:US
Mailing Address - Phone:214-750-1207
Mailing Address - Fax:214-750-8504
Practice Address - Street 1:8210 WALNUT HILL LN STE 130
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4418
Practice Address - Country:US
Practice Address - Phone:214-750-1207
Practice Address - Fax:214-750-8504
Is Sole Proprietor?:No
Enumeration Date:2021-07-02
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA14705363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical