Provider Demographics
NPI:1891523932
Name:CARLEY, BRYAN PATRICK (AGACNP-BC)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:PATRICK
Last Name:CARLEY
Suffix:
Gender:M
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1736 FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-5137
Mailing Address - Country:US
Mailing Address - Phone:949-290-8872
Mailing Address - Fax:
Practice Address - Street 1:1736 FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-5137
Practice Address - Country:US
Practice Address - Phone:949-290-8872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRNP309460363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology