Provider Demographics
NPI:1710403621
Name:CREWS, BRYSON EDWIN (PA-C)
Entity type:Individual
Prefix:
First Name:BRYSON
Middle Name:EDWIN
Last Name:CREWS
Suffix:
Gender:M
Credentials:PA-C
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 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-643-6400
Mailing Address - Fax:515-643-5816
Practice Address - Street 1:411 LAUREL ST STE 3250
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-3026
Practice Address - Country:US
Practice Address - Phone:515-643-6400
Practice Address - Fax:515-643-5816
Is Sole Proprietor?:No
Enumeration Date:2017-08-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3399363AM0700X
IA096160363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical