Provider Demographics
NPI:1043518673
Name:BRYANT, KENYA SADE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KENYA
Middle Name:SADE
Last Name:BRYANT
Suffix:
Gender:F
Credentials:PSYD
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 3286
Mailing Address - Street 2:
Mailing Address - City:FORT LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66027-0286
Mailing Address - Country:US
Mailing Address - Phone:816-292-8037
Mailing Address - Fax:
Practice Address - Street 1:902 BIDDLE AVE
Practice Address - Street 2:
Practice Address - City:FORT LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66027-0286
Practice Address - Country:US
Practice Address - Phone:816-292-8037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-07
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE482103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical