Provider Demographics
NPI:1407925399
Name:BRYAN, JULIA S (NP)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:S
Last Name:BRYAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 1ST AVE N
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37091-2826
Mailing Address - Country:US
Mailing Address - Phone:931-270-0050
Mailing Address - Fax:931-270-0052
Practice Address - Street 1:335 1ST AVE N
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:TN
Practice Address - Zip Code:37091-2826
Practice Address - Country:US
Practice Address - Phone:931-270-0050
Practice Address - Fax:931-270-0052
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5614363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3907310Medicaid
TN3732438Medicaid
TN4233400OtherBCBST
TN3907310Medicaid
TN4233400OtherBCBST
TN3732438Medicaid
TNP11493Medicare UPIN