# BRYAN P MATHIESON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1205022555
- **Gender:** Man
- **Credential:** NP

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | 71002603A | IN | Yes |
| 363L00000X | Nurse Practitioner | 78183 | ID | — |
| 363L00000X | Nurse Practitioner | 8890 | WI | — |
| 363LF0000X | Family Nurse Practitioner | 0024192011 | VA | — |
| 363LF0000X | Family Nurse Practitioner | 2015002005 | MO | — |
| 363LF0000X | Family Nurse Practitioner | 26537 | TN | — |
| 363LF0000X | Family Nurse Practitioner | 4704427019 | MI | — |

## Other

- **Enumeration date:** 09/20/2007
- **Last updated:** 12/17/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000584893 | ANTHEM | IN |
| 05 | — | 200889510 | — | IN |
| 05 | — | 3124112 | — | OH |