Provider Demographics
NPI:1306335773
Name:BRYANT, DESIREE BRIANA (LPN)
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:BRIANA
Last Name:BRYANT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 E ROBERT S KERR BLVD
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:OK
Mailing Address - Zip Code:73098-6621
Mailing Address - Country:US
Mailing Address - Phone:405-665-4351
Mailing Address - Fax:405-665-6372
Practice Address - Street 1:116 E ROBERT S KERR BLVD
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:OK
Practice Address - Zip Code:73098-6621
Practice Address - Country:US
Practice Address - Phone:405-665-4351
Practice Address - Fax:405-665-6372
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK59160164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse