Provider Demographics
NPI:1184879413
Name:BRYANT, SAOVAROT K (ANP)
Entity type:Individual
Prefix:
First Name:SAOVAROT
Middle Name:K
Last Name:BRYANT
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12855 N. FORTY DRIVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8666
Mailing Address - Country:US
Mailing Address - Phone:314-880-6100
Mailing Address - Fax:314-997-3248
Practice Address - Street 1:1027 BELLEVUE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1851
Practice Address - Country:US
Practice Address - Phone:314-645-6450
Practice Address - Fax:314-645-2560
Is Sole Proprietor?:No
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005040460163W00000X, 363LA2200X, 364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health