Provider Demographics
NPI:1821486556
Name:BRYANT, SAMANTHA JUNE (APRN NP-C)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JUNE
Last Name:BRYANT
Suffix:
Gender:F
Credentials:APRN NP-C
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Mailing Address - Street 1:131 SAUNDERSVILLE RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-8903
Mailing Address - Country:US
Mailing Address - Phone:423-458-6267
Mailing Address - Fax:423-790-7136
Practice Address - Street 1:260 16TH AVE
Practice Address - Street 2:UNIT 138
Practice Address - City:DAYTON
Practice Address - State:TN
Practice Address - Zip Code:37321-1071
Practice Address - Country:US
Practice Address - Phone:423-567-5003
Practice Address - Fax:423-428-9018
Is Sole Proprietor?:No
Enumeration Date:2015-01-05
Last Update Date:2016-07-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN0000019340363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ011195Medicaid
TNQ011195Medicaid