Provider Demographics
NPI:1528269289
Name:WILKINS-BRYSON, ALICE V (NP)
Entity type:Individual
Prefix:MRS
First Name:ALICE
Middle Name:V
Last Name:WILKINS-BRYSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 631982
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21263-1982
Mailing Address - Country:US
Mailing Address - Phone:757-668-7200
Mailing Address - Fax:757-668-9691
Practice Address - Street 1:2453 PRUDEN BLVD
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-4235
Practice Address - Country:US
Practice Address - Phone:757-539-7771
Practice Address - Fax:757-539-4360
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024164265363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00667250OtherRAILROAD MEDICARE
VA015409J66Medicare PIN
VAP00667250OtherRAILROAD MEDICARE