Provider Demographics
NPI:1770295354
Name:BRYANT, TAMMY KAY
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:KAY
Last Name:BRYANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 KELLANY LANE
Mailing Address - Street 2:
Mailing Address - City:EDGARTON
Mailing Address - State:WV
Mailing Address - Zip Code:25672
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:44 KELLANY LANE
Practice Address - Street 2:
Practice Address - City:EDGARTON
Practice Address - State:WV
Practice Address - Zip Code:25672
Practice Address - Country:US
Practice Address - Phone:304-733-1094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant