Provider Demographics
NPI:1447583885
Name:BRYAN, KRIS (APN)
Entity Type:Individual
Prefix:
First Name:KRIS
Middle Name:
Last Name:BRYAN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5745 JUNCTION CITY HWY
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-8754
Mailing Address - Country:US
Mailing Address - Phone:318-465-1795
Mailing Address - Fax:
Practice Address - Street 1:403 W OAK ST
Practice Address - Street 2:SUITE 200
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-4586
Practice Address - Country:US
Practice Address - Phone:870-875-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-17
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03266363LP2300X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR186301758Medicaid