Provider Demographics
NPI:1316647647
Name:BRYANT, KALLIE WHALEY (FNP)
Entity type:Individual
Prefix:
First Name:KALLIE
Middle Name:WHALEY
Last Name:BRYANT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KALLIE
Other - Middle Name:LEIGHT
Other - Last Name:WHALEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:99 WESTEDGE ST APT 326
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-4985
Mailing Address - Country:US
Mailing Address - Phone:910-296-3351
Mailing Address - Fax:
Practice Address - Street 1:171 ASHLEY AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-0100
Practice Address - Country:US
Practice Address - Phone:843-792-1414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27082363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily