Provider Demographics
NPI:1063462935
Name:BRYANT, ERIN B (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:B
Last Name:BRYANT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 CANARY DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-8538
Mailing Address - Country:US
Mailing Address - Phone:270-763-6363
Mailing Address - Fax:
Practice Address - Street 1:100 HELMWOOD PLAZA DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2975
Practice Address - Country:US
Practice Address - Phone:270-763-6363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3103P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000373492OtherANTHEM PIN
KY11350657OtherCAQH ID #
KY00485OtherMEDICARE GROUP #
KYQ26399Medicare UPIN
KY000000373492OtherANTHEM PIN