Provider Demographics
NPI:1316996572
Name:BRYAN, KRISTY LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:KRISTY
Middle Name:LYNN
Last Name:BRYAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KRISTY
Other - Middle Name:LYNN
Other - Last Name:PRICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 405827
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-5827
Mailing Address - Country:US
Mailing Address - Phone:870-934-5821
Mailing Address - Fax:870-934-5384
Practice Address - Street 1:1500 WEST POPLAR AVENUE
Practice Address - Street 2:SUITE 202
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017
Practice Address - Country:US
Practice Address - Phone:901-861-9090
Practice Address - Fax:901-861-9099
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000039119207R00000X
TN39119207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3331277Medicare PIN
I34309Medicare UPIN