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General NPI Number Information
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NPI Number | 1285199307
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Entity Type | Individual
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Provider Name | JESSICA BRYSKY PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/02/2019
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Last Update Date | 07/24/2023
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Provider Practice Location Address
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Address Line | 15245 BLUEBIRD ST NW
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City | ANDOVER
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State | MN
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Zip | 55304-3538
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Country | US
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Telephone | 763-587-4688
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Fax |
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Provider Business Mailing Address
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Address Line | 9762 SAGE GROVE CT
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City | LAS VEGAS
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State | NV
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Zip | 89148-5733
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Country | US
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Telephone | 651-717-8472
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 12917
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License Number State | MN
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