Provider Demographics
NPI:1720121114
Name:BRYANT, ANNETTE C (FNP)
Entity Type:Individual
Prefix:MS
First Name:ANNETTE
Middle Name:C
Last Name:BRYANT
Suffix:
Gender:F
Credentials:FNP
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 53
Mailing Address - Street 2:
Mailing Address - City:NEWELL
Mailing Address - State:SD
Mailing Address - Zip Code:57760-0053
Mailing Address - Country:US
Mailing Address - Phone:605-490-3127
Mailing Address - Fax:
Practice Address - Street 1:500 NORTH 5TH STREET
Practice Address - Street 2:VA BLACK HILLS HCS
Practice Address - City:HOT SPRINGS
Practice Address - State:SD
Practice Address - Zip Code:51747-0500
Practice Address - Country:US
Practice Address - Phone:605-745-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000464363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Not Answered363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIAB24202Medicaid
RIAB24202Medicaid