Provider Demographics
NPI:1750610432
Name:BRYANT, BETHANY M (PA)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:M
Last Name:BRYANT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4333 N JOSEY LN
Mailing Address - Street 2:SUITE 302
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-4629
Mailing Address - Country:US
Mailing Address - Phone:972-394-8844
Mailing Address - Fax:
Practice Address - Street 1:4333 N JOSEY LN
Practice Address - Street 2:SUITE 302
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4629
Practice Address - Country:US
Practice Address - Phone:972-394-8844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06411207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine