Provider Demographics
NPI:1639826167
Name:BRYANT, TYLER NICOLE
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:NICOLE
Last Name:BRYANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 998
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:AL
Mailing Address - Zip Code:35762-0998
Mailing Address - Country:US
Mailing Address - Phone:205-837-0395
Mailing Address - Fax:
Practice Address - Street 1:4900 MERIDIAN ST NW
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:AL
Practice Address - Zip Code:35762-7500
Practice Address - Country:US
Practice Address - Phone:256-372-7115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-04
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program