Provider Demographics
NPI:1588235642
Name:BRYAN, HEATHER (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:BRYAN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7426 N LA CHOLLA BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-2306
Mailing Address - Country:US
Mailing Address - Phone:541-203-4000
Mailing Address - Fax:262-260-9109
Practice Address - Street 1:395 SW BLUFF DR STE 10
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1670
Practice Address - Country:US
Practice Address - Phone:541-203-4000
Practice Address - Fax:262-260-9109
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202107341RN163W00000X
NC264609163W00000X
NC5014564363LP0808X
OR202107430NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse