Provider Demographics
NPI:1407226111
Name:BRYANT, NICOLE HORNE
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:HORNE
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 1:1712 WATERFORD DR NW
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27896-1589
Mailing Address - Country:US
Mailing Address - Phone:252-373-0825
Mailing Address - Fax:252-509-0454
Practice Address - Street 1:1712 WATERFORD DR NW
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27896-1589
Practice Address - Country:US
Practice Address - Phone:252-373-0825
Practice Address - Fax:252-509-0454
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-07
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency