Provider Demographics
NPI:1821888488
Name:BRYANT, SAMANTHA JADE
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JADE
Last Name:BRYANT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:JADE
Other - Last Name:HIGGINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:338 STONEY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-4270
Mailing Address - Country:US
Mailing Address - Phone:304-920-9395
Mailing Address - Fax:
Practice Address - Street 1:338 STONEY RIDGE RD
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701-4270
Practice Address - Country:US
Practice Address - Phone:304-920-9395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist