Provider Demographics
NPI:1720880412
Name:DOTSON, BRYCE (MSN, RN, AGACNP-BC)
Entity type:Individual
Prefix:MR
First Name:BRYCE
Middle Name:
Last Name:DOTSON
Suffix:
Gender:
Credentials:MSN, RN, AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7230 ARBUCKLE CMNS STE 178
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-2286
Mailing Address - Country:US
Mailing Address - Phone:317-456-2764
Mailing Address - Fax:
Practice Address - Street 1:7230 ARBUCKLE CMNS STE 178
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-2286
Practice Address - Country:US
Practice Address - Phone:317-456-2764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN2024063763363LA2100X, 363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology