Provider Demographics
NPI:1356340707
Name:BRIANT, DAVID R (RNP)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:R
Last Name:BRIANT
Suffix:
Gender:M
Credentials:RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8046 E YAVAPAI RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-8442
Mailing Address - Country:US
Mailing Address - Phone:928-772-6707
Mailing Address - Fax:928-772-6773
Practice Address - Street 1:8046 E YAVAPAI RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-8442
Practice Address - Country:US
Practice Address - Phone:928-772-6707
Practice Address - Fax:928-772-6773
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN037656363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ128662Medicaid
AZZ69935Medicare ID - Type UnspecifiedMEDICARE ID
AZR17623Medicare UPIN