Provider Demographics
NPI:1801869748
Name:BRYANT, KATHLEEN A (NP)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:A
Last Name:BRYANT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:ATT: CVMC FINANCE DEPT
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-0547
Mailing Address - Country:US
Mailing Address - Phone:802-371-5950
Mailing Address - Fax:802-371-5951
Practice Address - Street 1:246 GRANGER RD
Practice Address - Street 2:SUITE 1
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05602-9516
Practice Address - Country:US
Practice Address - Phone:802-371-5950
Practice Address - Fax:802-371-5951
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA216464363L00000X
VT101.0022960363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1015078Medicaid
MA0394190Medicaid
MABR NP3930Medicare ID - Type Unspecified
VT1015078Medicaid
VT000720301Medicare PIN