Provider Demographics
NPI:1336578954
Name:BRYANT, KIMBERLY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:
Last Name:BRYANT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:KIMBERLY
Other - Middle Name:JANE
Other - Last Name:ALBEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:210 SFC 420
Mailing Address - Street 2:
Mailing Address - City:FORREST CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72335
Mailing Address - Country:US
Mailing Address - Phone:870-270-9714
Mailing Address - Fax:
Practice Address - Street 1:810A NEWMAN DR
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:AR
Practice Address - Zip Code:72342-8950
Practice Address - Country:US
Practice Address - Phone:870-338-7441
Practice Address - Fax:870-338-7945
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP-T1338363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant