Provider Demographics
NPI:1407934516
Name:BRYANT, JASON SCOTT (MSN-CRNA)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:SCOTT
Last Name:BRYANT
Suffix:
Gender:M
Credentials:MSN-CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12752 KINGSTON PIKE
Mailing Address - Street 2:STE E202
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-0948
Mailing Address - Country:US
Mailing Address - Phone:865-777-0909
Mailing Address - Fax:865-777-0910
Practice Address - Street 1:301 TYSON AVE
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-4544
Practice Address - Country:US
Practice Address - Phone:865-777-0909
Practice Address - Fax:865-777-0910
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANA3255207L00000X
TNRN163959367500000X
TNAPN13224367500000X
KY5816A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00810608OtherRAILROAD MEDICARE
TN1515836Medicaid
TN4235686OtherBLUE CROSS/BLUE SHIELD
TN4235686OtherBLUE CROSS/BLUE SHIELD
CANA3255Medicare ID - Type Unspecified