Healthcare Provider Details

I. General information

NPI: 1306388350
Provider Name (Legal Business Name): LANCE BRYSON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2016
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 J D ANDERSON DR SUITE 401
MORGANTOWN WV
26505-1241
US

IV. Provider business mailing address

1000 J D ANDERSON DR STE 401
MORGANTOWN WV
26505-1238
US

V. Phone/Fax

Practice location:
  • Phone: 304-599-3074
  • Fax: 304-598-1802
Mailing address:
  • Phone: 304-599-3074
  • Fax: 304-598-1802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2787
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: