Provider Demographics
NPI:1487052379
Name:SIMPSON, BRYLA N (PA-C)
Entity type:Individual
Prefix:MISS
First Name:BRYLA
Middle Name:N
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BRYLA
Other - Middle Name:N
Other - Last Name:RENFRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1303 MCCULLOUGH AVE. STE 135
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212
Mailing Address - Country:US
Mailing Address - Phone:210-227-9214
Mailing Address - Fax:210-476-8515
Practice Address - Street 1:1303 MCCULLOUGH AVE STE 135
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212
Practice Address - Country:US
Practice Address - Phone:210-227-9214
Practice Address - Fax:210-476-8515
Is Sole Proprietor?:No
Enumeration Date:2014-12-09
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA09426363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical