MEDICARE: MR. RANDY WAYNE BRYSON FNP

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	790930	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	:	1861540254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RANDY WAYNE BRYSON FNP

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	:	512-244-2895

Provider Business Practice Location Address
First Line	:	3500 HILLCREST DR STE 1
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76708-3144
Country	:	US
Telephone Number	:	254-741-6641
Fax Number	:	254-537-4693

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

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	01/06/2021

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