Provider Demographics
NPI:1053073387
Name:DAVIS, BRYN LAUREN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:BRYN
Middle Name:LAUREN
Last Name:DAVIS
Suffix:
Gender:F
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 1:12121 ADMIRALTY WAY APT K201
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-7532
Mailing Address - Country:US
Mailing Address - Phone:315-725-2656
Mailing Address - Fax:
Practice Address - Street 1:21600 HIGHWAY 99 STE 240
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-5139
Practice Address - Country:US
Practice Address - Phone:425-673-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-13
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110007957363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant