Provider Demographics
NPI:1881881274
Name:BRYANT, JERIN D (PA)
Entity type:Individual
Prefix:MRS
First Name:JERIN
Middle Name:D
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 1:227 W KLEBERG AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78363-4427
Mailing Address - Country:US
Mailing Address - Phone:361-592-6451
Mailing Address - Fax:361-595-4545
Practice Address - Street 1:227 W KLEBERG AVE
Practice Address - Street 2:
Practice Address - City:KINGSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78363-4427
Practice Address - Country:US
Practice Address - Phone:361-592-6451
Practice Address - Fax:361-595-4545
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03924363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant