Provider Demographics
NPI:1750313748
Name:BRYANT, CHRIS N (DPM)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:N
Last Name:BRYANT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 NICHOLASVILLE RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2520
Mailing Address - Country:US
Mailing Address - Phone:859-278-7313
Mailing Address - Fax:859-260-1007
Practice Address - Street 1:2130 NICHOLASVILLE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2520
Practice Address - Country:US
Practice Address - Phone:859-278-7313
Practice Address - Fax:859-260-1007
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY0245213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY80000011Medicaid
KY5146650001OtherMEDICARE DME
KY1840302Medicare ID - Type Unspecified
KY80000011Medicaid
KY0087202Medicare PIN