Provider Demographics
NPI:1184333247
Name:NELYANT INTEGRATED HEALTHCARE
Entity type:Organization
Organization Name:NELYANT INTEGRATED HEALTHCARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF MEDICAL OPERATIONS
Authorized Official - Prefix:DR
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:MCNOVA
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, FNP-C
Authorized Official - Phone:480-788-0240
Mailing Address - Street 1:7252 W ST CATHERINE AVE
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-2693
Mailing Address - Country:US
Mailing Address - Phone:806-414-8040
Mailing Address - Fax:
Practice Address - Street 1:7252 W ST CATHERINE AVE
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-2693
Practice Address - Country:US
Practice Address - Phone:806-414-8040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INSTANOVA HEALTH PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-17
Last Update Date:2024-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)