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 1:8333 NAAB RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5924
Mailing Address - Country:US
Mailing Address - Phone:317-396-1300
Mailing Address - Fax:317-876-4070
Practice Address - Street 1:8333 NAAB RD
Practice Address - Street 2:SUITE 250
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5924
Practice Address - Country:US
Practice Address - Phone:317-396-1300
Practice Address - Fax:317-876-4070
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001797A363L00000X, 363LA2200X
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