Basic Information
| Provider Information | |||||||||
| NPI: | 1700450780 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SKINNER | ||||||||
| FirstName: | BRYNN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 42D MEDICAL GROUP, 300 S. TWINING ST. BLDG. 760 | ||||||||
| Address2: | |||||||||
| City: | MAXWELL AFB | ||||||||
| State: | AL | ||||||||
| PostalCode: | 36112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3349533368 | ||||||||
| FaxNumber: | 3349538607 | ||||||||
| Practice Location | |||||||||
| Address1: | 42D MEDICAL GROUP, 300 S. TWINING ST. BLDG. 760 | ||||||||
| Address2: | |||||||||
| City: | MAXWELL AFB | ||||||||
| State: | AL | ||||||||
| PostalCode: | 36112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3349533368 | ||||||||
| FaxNumber: | 3349538607 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2021 | ||||||||
| LastUpdateDate: | 09/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.