Provider Demographics
NPI:1225708639
Name:BRYANT, PAMELA HARRIS (CRNP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:HARRIS
Last Name:BRYANT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5528 LAKE CYRUS LN
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-4187
Mailing Address - Country:US
Mailing Address - Phone:205-567-2190
Mailing Address - Fax:
Practice Address - Street 1:1600 5TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1700
Practice Address - Country:US
Practice Address - Phone:205-638-6971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-069737363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics