Provider Demographics
NPI:1114074002
Name:BRYANT-MELVIN, KRISTINA M (MD)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:M
Last Name:BRYANT-MELVIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:M
Other - Last Name:BRYANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1115 20TH STREET
Mailing Address - Street 2:SUITE 205
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25703
Mailing Address - Country:US
Mailing Address - Phone:304-691-1500
Mailing Address - Fax:304-691-1510
Practice Address - Street 1:1115 20TH STREET
Practice Address - Street 2:SUITE 205
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25703
Practice Address - Country:US
Practice Address - Phone:304-691-1500
Practice Address - Fax:304-691-1510
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV241932084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry