Healthcare Provider Details

I. General information

NPI: 1528245529
Provider Name (Legal Business Name): DARLENE MARY BRY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2008
Last Update Date: 09/20/2021
Certification Date: 09/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 TRUXTUN AVE STE 400
BAKERSFIELD CA
93301-5220
US

IV. Provider business mailing address

2 FOXBORO RD
SAINT LOUIS MO
63124-1268
US

V. Phone/Fax

Practice location:
  • Phone: 661-635-3050
  • Fax:
Mailing address:
  • Phone: 314-983-9093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number59516
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number106741
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: