Provider Demographics
NPI:1346759438
Name:O'BRYANT, MINDY BETH (CRNP)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:BETH
Last Name:O'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 1:3907 HOOD DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHSIDE
Mailing Address - State:AL
Mailing Address - Zip Code:35907-7096
Mailing Address - Country:US
Mailing Address - Phone:256-689-1038
Mailing Address - Fax:
Practice Address - Street 1:3907 HOOD DR
Practice Address - Street 2:
Practice Address - City:SOUTHSIDE
Practice Address - State:AL
Practice Address - Zip Code:35907-7096
Practice Address - Country:US
Practice Address - Phone:256-689-1038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-21
Last Update Date:2017-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-107565363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily