Provider Demographics
NPI:1528423639
Name:BRYANT, KRISTEN NICOLE (NP-C)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:NICOLE
Last Name:BRYANT
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 INDIAN DR
Mailing Address - Street 2:
Mailing Address - City:EASTMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31023-7670
Mailing Address - Country:US
Mailing Address - Phone:478-374-1778
Mailing Address - Fax:
Practice Address - Street 1:1120 INDIAN DR
Practice Address - Street 2:
Practice Address - City:EASTMAN
Practice Address - State:GA
Practice Address - Zip Code:31023-7670
Practice Address - Country:US
Practice Address - Phone:478-374-1778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-17
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN183917363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily