Provider Demographics
NPI:1063095875
Name:BRYANT, NIKIDA (RN)
Entity type:Individual
Prefix:
First Name:NIKIDA
Middle Name:
Last Name:BRYANT
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13302 SHANAGARRY DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-8191
Mailing Address - Country:US
Mailing Address - Phone:336-769-7939
Mailing Address - Fax:
Practice Address - Street 1:13302 SHANAGARRY DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28278-8191
Practice Address - Country:US
Practice Address - Phone:336-769-7939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-29
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC250856163W00000X
NC5021592363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse