Provider Demographics
NPI:1801781406
Name:BRYANT, TINA
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:BRYANT
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 96
Mailing Address - Street 2:
Mailing Address - City:VERDUNVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25649-0096
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:37 BRISTOL PARK LANE
Practice Address - Street 2:ROUTE 5
Practice Address - City:VERDUNVILLE
Practice Address - State:WV
Practice Address - Zip Code:25649
Practice Address - Country:US
Practice Address - Phone:304-752-4582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide