Provider Demographics
NPI:1295454866
Name:BRYANT, SHEKENDRA PATTY
Entity type:Individual
Prefix:
First Name:SHEKENDRA
Middle Name:PATTY
Last Name:BRYANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 277
Mailing Address - Street 2:
Mailing Address - City:SHAW
Mailing Address - State:MS
Mailing Address - Zip Code:38773-0277
Mailing Address - Country:US
Mailing Address - Phone:662-588-1584
Mailing Address - Fax:
Practice Address - Street 1:138 E PEELER SUITE277
Practice Address - Street 2:-277
Practice Address - City:SHAW
Practice Address - State:MS
Practice Address - Zip Code:38773-0277
Practice Address - Country:US
Practice Address - Phone:662-588-1584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program