Provider Demographics
NPI:1902201700
Name:CARLETON, BRYAN R (APRN, DNP)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:R
Last Name:CARLETON
Suffix:
Gender:
Credentials:APRN, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 4TH ST NW
Mailing Address - Street 2:
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-5089
Mailing Address - Country:US
Mailing Address - Phone:507-384-6830
Mailing Address - Fax:
Practice Address - Street 1:400 4TH ST NW
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-5089
Practice Address - Country:US
Practice Address - Phone:507-384-6830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-23
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2593363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health