Provider Demographics
NPI:1710906078
Name:BRYANT, NATALIE L (APRN)
Entity Type:Individual
Prefix:MISS
First Name:NATALIE
Middle Name:L
Last Name:BRYANT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 PARK ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1759
Mailing Address - Country:US
Mailing Address - Phone:270-782-4746
Mailing Address - Fax:270-783-0453
Practice Address - Street 1:990 WILKINSON TRCE
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-3404
Practice Address - Country:US
Practice Address - Phone:270-782-4746
Practice Address - Fax:270-783-0453
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3710363L00000X
KY3004716363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100099470Medicaid
Q71213Medicare UPIN
AZ541178Medicaid
Z138954Medicare PIN
KYK075410Medicare PIN