Provider Demographics
NPI:1194709196
Name:BRYANT, KRISTINA KRUER (MD)
Entity type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:KRUER
Last Name:BRYANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:502-588-2348
Mailing Address - Fax:502-588-2334
Practice Address - Street 1:210 E GRAY ST
Practice Address - Street 2:STE 802
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3904
Practice Address - Country:US
Practice Address - Phone:502-588-2348
Practice Address - Fax:502-588-2334
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY31275208000000X, 2080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200272740Medicaid
KY64011620Medicaid
KYP400035118Medicare PIN
KYK054430Medicare PIN