Provider Demographics
NPI:1194215178
Name:BRYANT, PAMELA MARIE
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:MARIE
Last Name:BRYANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 PRIVATE ROAD 7270
Mailing Address - Street 2:
Mailing Address - City:SAN AUGUSTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75972-5660
Mailing Address - Country:US
Mailing Address - Phone:936-219-5893
Mailing Address - Fax:
Practice Address - Street 1:188 PRIVATE ROAD 7270
Practice Address - Street 2:
Practice Address - City:SAN AUGUSTINE
Practice Address - State:TX
Practice Address - Zip Code:75972-5660
Practice Address - Country:US
Practice Address - Phone:936-219-5893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX173633164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse