Provider Demographics
NPI:1427847664
Name:O'BRYANT, IVY
Entity type:Individual
Prefix:
First Name:IVY
Middle Name:
Last Name:O'BRYANT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4949 VISTA FLORA WAY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-2946
Mailing Address - Country:US
Mailing Address - Phone:725-310-0699
Mailing Address - Fax:
Practice Address - Street 1:4949 VISTA FLORA WAY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-2946
Practice Address - Country:US
Practice Address - Phone:725-310-0699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide