Provider Demographics
NPI:1780330407
Name:BRYANT, JENNIFER M (NP)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:M
Last Name:BRYANT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:113 SILVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-9471
Mailing Address - Country:US
Mailing Address - Phone:478-279-2154
Mailing Address - Fax:
Practice Address - Street 1:639 HEMLOCK ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-6886
Practice Address - Country:US
Practice Address - Phone:478-755-1560
Practice Address - Fax:478-745-3534
Is Sole Proprietor?:No
Enumeration Date:2022-02-22
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN209380363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily