Provider Demographics
NPI:1922364348
Name:BRYANT, KRISTAL L (RD)
Entity type:Individual
Prefix:
First Name:KRISTAL
Middle Name:L
Last Name:BRYANT
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 NE ROSS RD
Mailing Address - Street 2:SPC 45
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-7389
Mailing Address - Country:US
Mailing Address - Phone:512-470-6704
Mailing Address - Fax:
Practice Address - Street 1:725 NE ROSS RD
Practice Address - Street 2:SPC 45
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-7389
Practice Address - Country:US
Practice Address - Phone:512-470-6704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLD-D-10175332133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered