Provider Demographics
NPI:1861540254
Name:BRYSON, RANDY WAYNE (FNP)
Entity type:Individual
Prefix:MR
First Name:RANDY
Middle Name:WAYNE
Last Name:BRYSON
Suffix:
Gender:M
Credentials:FNP
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Mailing Address - Street 1:2000 S MAYS ST STE 201
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-7580
Mailing Address - Country:US
Mailing Address - Phone:512-244-4272
Mailing Address - Fax:512-244-2895
Practice Address - Street 1:3500 HILLCREST DR STE 1
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76708-3144
Practice Address - Country:US
Practice Address - Phone:254-741-6641
Practice Address - Fax:254-537-4693
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2021-01-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX790930363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX390244701Medicaid