Provider Demographics
NPI:1851361547
Name:BRYANT, SHARON L (PHD)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:L
Last Name:BRYANT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 BRADFORD WAY
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:37763
Mailing Address - Country:US
Mailing Address - Phone:865-376-1585
Mailing Address - Fax:865-376-1587
Practice Address - Street 1:1002 BRADFORD WAY
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:TN
Practice Address - Zip Code:37763
Practice Address - Country:US
Practice Address - Phone:865-376-1585
Practice Address - Fax:865-376-1587
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP1453103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3683286Medicaid
TN0133074OtherBLUE CROSS BLUE SHIELD
TN0133074OtherBLUE CROSS BLUE SHIELD