Healthcare Provider Details

I. General information

NPI: 1750434171
Provider Name (Legal Business Name): SHELLEY LYNN BRYANT MSN, NPC, WHC, ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1022 E GRIFFIN PKWY STE 101
MISSION TX
78572-2401
US

IV. Provider business mailing address

PO BOX 1867
MISSION TX
78573-0031
US

V. Phone/Fax

Practice location:
  • Phone: 956-581-2168
  • Fax: 956-581-2169
Mailing address:
  • Phone: 956-581-2168
  • Fax: 956-581-2169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number231842
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: