Provider Demographics
NPI:1285797910
Name:BRYANT-PITTS, WILLIENELL H (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIENELL
Middle Name:H
Last Name:BRYANT-PITTS
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 1:2815 WHIPPOORWILL LN
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-1517
Mailing Address - Country:US
Mailing Address - Phone:580-233-4696
Mailing Address - Fax:
Practice Address - Street 1:216 N MURRAY ST
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:OK
Practice Address - Zip Code:73741-1017
Practice Address - Country:US
Practice Address - Phone:580-852-3221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-17
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK182152080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKC61162Medicare UPIN