Provider Demographics
NPI:1043802606
Name:LANKFORD, BRYAN (APRN)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:LANKFORD
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2806 W CACTUS RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-3364
Mailing Address - Country:US
Mailing Address - Phone:602-607-4700
Mailing Address - Fax:
Practice Address - Street 1:2806 W CACTUS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-3364
Practice Address - Country:US
Practice Address - Phone:602-607-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRNP250534363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner