Provider Demographics
NPI:1437134772
Name:BRYANT, KIMBERLY MICHELE (RN, MSN, APRN-BC)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:MICHELE
Last Name:BRYANT
Suffix:
Gender:F
Credentials:RN, MSN, APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:679 E COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1049
Mailing Address - Country:US
Mailing Address - Phone:317-890-2000
Mailing Address - Fax:317-859-7220
Practice Address - Street 1:11380 ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-9840
Practice Address - Country:US
Practice Address - Phone:317-890-2000
Practice Address - Fax:317-859-7220
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2025-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001797A363LA2200X, 363L00000X
IN28149565A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200495240Medicaid
IN000000545975OtherANTHEM BLUE CROSS AND BLUE SHIELD
Q26417Medicare UPIN
IN061570YYMedicare ID - Type Unspecified