Provider Demographics
NPI:1033143573
Name:BRYANT, JAMIE S (APRN)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:S
Last Name:BRYANT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3707 CHAMBERLAIN LN STE 101
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-2091
Mailing Address - Country:US
Mailing Address - Phone:502-426-9200
Mailing Address - Fax:502-426-9259
Practice Address - Street 1:3707 CHAMBERLAIN LN STE 101
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2091
Practice Address - Country:US
Practice Address - Phone:502-426-9200
Practice Address - Fax:502-426-9259
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3003971363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200869410Medicaid
KY78013372Medicaid
P92286Medicare UPIN
IN200869410Medicaid
KYMB1593311OtherDEA
P92286Medicare UPIN