Provider Demographics
NPI:1386335222
Name:SMALL, BRYANTNEKA KIMMAL
Entity type:Individual
Prefix:
First Name:BRYANTNEKA
Middle Name:KIMMAL
Last Name:SMALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8655 JONES RD APT 338
Mailing Address - Street 2:
Mailing Address - City:JERSEY VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:77065-5102
Mailing Address - Country:US
Mailing Address - Phone:346-324-7205
Mailing Address - Fax:
Practice Address - Street 1:8655 JONES RD APT 338
Practice Address - Street 2:
Practice Address - City:JERSEY VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:77065-5102
Practice Address - Country:US
Practice Address - Phone:346-324-7205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)