Provider Demographics
NPI:1740892777
Name:BRYANT, ERNEST JAMES
Entity type:Individual
Prefix:
First Name:ERNEST
Middle Name:JAMES
Last Name:BRYANT
Suffix:
Gender:M
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 338
Mailing Address - Street 2:
Mailing Address - City:ALDERSON
Mailing Address - State:WV
Mailing Address - Zip Code:24910-0338
Mailing Address - Country:US
Mailing Address - Phone:304-445-6439
Mailing Address - Fax:
Practice Address - Street 1:6741 FLAY MTN. RD
Practice Address - Street 2:
Practice Address - City:ALDERSON
Practice Address - State:WV
Practice Address - Zip Code:24910
Practice Address - Country:US
Practice Address - Phone:304-445-6439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-20
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant