Active NPI
Bruce Douglas Clyne, CRNP
- Nurse Practitioner
- Columbus, GA
National Provider Identifier
1720196165
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 1-077041
- Practice address
- 1310 13TH Avenue
VA Clinic
Columbus, GA 31902 - Phone
- (706) 257-7200
- Fax
- (706) 653-6645
- NPI assigned
- Aug 27, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 1-077041 | AL | Primary |
Addresses
Primary practice location
1310 13TH Avenue
VA Clinic
Columbus, GA 31902
Mailing address
62 Stillwaters Grove
Dadeville, AL 36853
Phone (256) 625-9206
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1-077041 | AL | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156636800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184112000000",
"number": "1720196165",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "62 STILLWATERS GROVE",
"city": "DADEVILLE",
"state": "AL",
"postal_code": "36853",
"telephone_number": "256-625-9206",
"fax_number": "706-653-6645"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1310 13TH AVENUE",
"address_2": "VA CLINIC",
"city": "COLUMBUS",
"state": "GA",
"postal_code": "31902",
"telephone_number": "706-257-7200",
"fax_number": "706-653-6645"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLYNE",
"first_name": "BRUCE",
"middle_name": "DOUGLAS",
"credential": "CRNP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-27",
"last_updated": "2007-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "AL",
"license": "1-077041",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbus, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.