MEDICARE: ASHLEY NICOLE BRYCE RN, MSN, FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	726592	TX

General Provider Information

NPI Number	:	1437573201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY NICOLE BRYCE RN, MSN, FNP-C

Provider Business Mailing Address
First Line	:	2501 JIMMY JOHNSON BLVD STE 405
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77640-2013
Country	:	US
Telephone Number	:	409-722-6553
Fax Number	:	409-722-1885

Provider Business Practice Location Address
First Line	:	2501 JIMMY JOHNSON BLVD STE 405
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77640-2013
Country	:	US
Telephone Number	:	409-722-6553
Fax Number	:	409-722-1885

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2014
Last Update Date	:	11/20/2014

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