Basic Information
| Provider Information | |||||||||
| NPI: | 1619342821 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRYAN | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | AUGUSTUS | ||||||||
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| Credential: | ACNS-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1191 ELLIOTT RANCH RD | ||||||||
| Address2: | |||||||||
| City: | BUDA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786109395 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5126940078 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7600 N CAPITAL OF TEXAS HWY | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787311184 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5129014937 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2015 | ||||||||
| LastUpdateDate: | 12/14/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SA2200X | AP113511 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Adult Health |
No ID Information.