Provider Demographics
NPI:1558964684
Name:BRYAN, MARRISSA LYNN (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:MARRISSA
Middle Name:LYNN
Last Name:BRYAN
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:MARRISSA
Other - Middle Name:LYNN
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1079 KINGSTON HWY
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30145-1905
Mailing Address - Country:US
Mailing Address - Phone:470-232-5995
Mailing Address - Fax:
Practice Address - Street 1:1780 OLD HIGHWAY 41 NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-4428
Practice Address - Country:US
Practice Address - Phone:770-427-7256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN249699163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse