Provider Demographics
NPI:1699351395
Name:BRYSON, AMBER MARISSA
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:MARISSA
Last Name:BRYSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:MARISSA
Other - Last Name:BRYSON-JENNINGS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:1236 MARY JANE AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38116-8903
Mailing Address - Country:US
Mailing Address - Phone:901-210-9712
Mailing Address - Fax:
Practice Address - Street 1:1236 MARY JANE AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-8903
Practice Address - Country:US
Practice Address - Phone:901-210-9712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN96668164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse