MEDICARE: LAURA M BRYNESTAD AGACNP

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	163W00000X	Registered Nurse	1-123450	AL
2	363LA2100X	Acute Care Nurse Practitioner	1-123450	AL
3	363LA2100X	Acute Care Nurse Practitioner	AP128088	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649510785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA M BRYNESTAD AGACNP

Provider Business Mailing Address
First Line	:	2000 S MAYS ST STE 201
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78664-7580
Country	:	US
Telephone Number	:	512-244-4272
Fax Number	:

Provider Business Practice Location Address
First Line	:	351 CYPRESS CREEK RD STE 202
Second Line	:
City	:	CEDAR PARK
State	:	TX
Zip	:	78613-4657
Country	:	US
Telephone Number	:	512-244-4272
Fax Number	:

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

Provider Enumeration Date	:	02/27/2013
Last Update Date	:	04/21/2021

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