Healthcare Provider Details

I. General information

NPI: 1912588054
Provider Name (Legal Business Name): BRYAN WESLEY KROMENACKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2021
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 W PLANO PKWY STE 100
PLANO TX
75093-4851
US

IV. Provider business mailing address

5300 W PLANO PKWY STE 100
PLANO TX
75093-4851
US

V. Phone/Fax

Practice location:
  • Phone: 972-403-1463
  • Fax:
Mailing address:
  • Phone: 972-403-1463
  • Fax: 833-449-4877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberV1161
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: