Provider Demographics
NPI:1548229024
Name:BRYANT, KARLA JEAN (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:KARLA
Middle Name:JEAN
Last Name:BRYANT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5602 RUDDELL RD SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503
Mailing Address - Country:US
Mailing Address - Phone:360-438-0394
Mailing Address - Fax:360-493-0824
Practice Address - Street 1:5602 RUDDELL RD SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503
Practice Address - Country:US
Practice Address - Phone:360-438-0394
Practice Address - Fax:360-493-0824
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30003185363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9676848Medicaid
AB37795Medicare ID - Type Unspecified
WA9676848Medicaid