Provider Demographics
NPI:1356384978
Name:BRYANT, AMY M (APN)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:BRYANT
Suffix:
Gender:F
Credentials:APN
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 400
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38302-0400
Mailing Address - Country:US
Mailing Address - Phone:731-425-5752
Mailing Address - Fax:731-422-5743
Practice Address - Street 1:700 W FOREST AVE STE 300
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301
Practice Address - Country:US
Practice Address - Phone:731-422-0213
Practice Address - Fax:731-422-0471
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000006644363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4083544OtherTENN CARE SELECT
TN000000156117OtherUNISON
TN3345634Medicaid
TN4083544OtherBLUE CROSS BLUE SHIELD TN
TN3345634Medicare ID - Type UnspecifiedCIGNA GOVERNMENT BENEFIT
TNS56342Medicare UPIN