Provider Demographics
NPI:1164471173
Name:MILLER, BRYAN MICHAEL (RN, MS, BSN)
Entity type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:MICHAEL
Last Name:MILLER
Suffix:
Gender:M
Credentials:RN, MS, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2509 KENNEDY CIR BLDG 125
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78235-5116
Mailing Address - Country:US
Mailing Address - Phone:361-229-3483
Mailing Address - Fax:
Practice Address - Street 1:2509 KENNEDY CIR BLDG 125
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78235-5116
Practice Address - Country:US
Practice Address - Phone:210-704-3905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2020-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXB1210229146N00000X
1710I1002X, 246ZS0410X
TX864435163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist