MEDICARE: MR. BRYAN NEBA NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	1015269	TX

General Provider Information

NPI Number	:	1104428010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRYAN NEBA NP

Provider Business Mailing Address
First Line	:	2301 S FM 51 STE 500
Second Line	:
City	:	DECATUR
State	:	TX
Zip	:	76234-3867
Country	:	US
Telephone Number	:	940-627-0013
Fax Number	:

Provider Business Practice Location Address
First Line	:	4130 N COLLINS ST
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76005-4547
Country	:	US
Telephone Number	:	817-809-8760
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2020
Last Update Date	:	10/10/2024

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