Healthcare Provider Details

I. General information

NPI: 1740851633
Provider Name (Legal Business Name): BRYN ELISE BUMPASS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRYN ELISE JENSEN

II. Dates (important events)

Enumeration Date: 07/02/2021
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8210 WALNUT HILL LN STE 130
DALLAS TX
75231-4418
US

IV. Provider business mailing address

8210 WALNUT HILL LN STE 130
DALLAS TX
75231-4418
US

V. Phone/Fax

Practice location:
  • Phone: 214-750-1207
  • Fax: 214-750-8504
Mailing address:
  • Phone: 214-750-1207
  • Fax: 214-750-8504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA14705
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: