Provider Demographics
NPI:1285871053
Name:BRYANT, KATHYANN CYNTHELESE (LSA)
Entity type:Individual
Prefix:MS
First Name:KATHYANN
Middle Name:CYNTHELESE
Last Name:BRYANT
Suffix:
Gender:F
Credentials:LSA
Other - Prefix:
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Mailing Address - Street 1:PO BOX 541602
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77254-1602
Mailing Address - Country:US
Mailing Address - Phone:832-428-7532
Mailing Address - Fax:832-602-2638
Practice Address - Street 1:10133 IRVINGTON BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77076-4412
Practice Address - Country:US
Practice Address - Phone:832-428-7532
Practice Address - Fax:832-602-2638
Is Sole Proprietor?:No
Enumeration Date:2009-01-14
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT034925225700000X
TXSA00606246ZC0007X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00P07UOtherBCBS - OLTON SURGICAL SERVICES, LLC
TXSA00606OtherTEXAS MEDICAL BOARD