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General NPI Number Information
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NPI Number | 1700643392
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Entity Type | Individual
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Provider Name | BRYANT ROBERSON APRN-CNP
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Gender | Male
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Dates
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Enumeration Date | 03/01/2024
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Last Update Date | 03/01/2024
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Provider Practice Location Address
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Address Line | 1010 RANCH ROAD 620 S STE 107
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City | LAKEWAY
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State | TX
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Zip | 78734-5638
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Country | US
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Telephone | 512-960-2165
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Fax |
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Provider Business Mailing Address
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Address Line | 427 SUMMER POINTE DR
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City | BUDA
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State | TX
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Zip | 78610-5909
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Country | US
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Telephone | 512-420-6789
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 1076152
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License Number State | TX
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