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NPI Code Detail

MEDICARE: DR. BRYAN WESLEY KROMENACKER MD

MEDICARE: DR. BRYAN WESLEY KROMENACKER MD
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
12084P0800XPsychiatry PhysicianV1161TX

General Provider Information

NPI Number : 1912588054
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRYAN WESLEY KROMENACKER MD
Provider Business Mailing Address
First Line : 5300 W PLANO PKWY STE 100
Second Line :
City : PLANO
State : TX
Zip : 75093-4851
Country : US
Telephone Number : 972-403-1463
Fax Number : 833-449-4877
Provider Business Practice Location Address
First Line : 5300 W PLANO PKWY STE 100
Second Line :
City : PLANO
State : TX
Zip : 75093-4851
Country : US
Telephone Number : 972-403-1463
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2021
Last Update Date : 10/03/2025

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