Provider Demographics
NPI:1801489760
Name:BRYSON, KARLENE BEVERLEY (PA)
Entity type:Individual
Prefix:
First Name:KARLENE
Middle Name:BEVERLEY
Last Name:BRYSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 LOCUSTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-2009
Mailing Address - Country:US
Mailing Address - Phone:347-424-6195
Mailing Address - Fax:
Practice Address - Street 1:176 LOCUSTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-2009
Practice Address - Country:US
Practice Address - Phone:347-424-6195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006724-01363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant