Provider Demographics
NPI:1962946137
Name:BRYAN, HAYLEY PLANT (PA)
Entity type:Individual
Prefix:
First Name:HAYLEY
Middle Name:PLANT
Last Name:BRYAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:HAYLEY
Other - Middle Name:
Other - Last Name:PLANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 TWO ISLAND CT UNIT E
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-7418
Mailing Address - Country:US
Mailing Address - Phone:854-444-7676
Mailing Address - Fax:854-999-0549
Practice Address - Street 1:1200 TWO ISLAND CT UNIT E
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-7418
Practice Address - Country:US
Practice Address - Phone:854-444-7676
Practice Address - Fax:854-999-0549
Is Sole Proprietor?:No
Enumeration Date:2016-12-07
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2642363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3933PAMedicaid