Provider Demographics
NPI:1912111733
Name:BRYANT-MCKENNEY, HEATHER ANN (NP)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:ANN
Last Name:BRYANT-MCKENNEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 PAUL ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-3646
Mailing Address - Country:US
Mailing Address - Phone:781-821-2183
Mailing Address - Fax:
Practice Address - Street 1:101 ACCESS RD
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-5211
Practice Address - Country:US
Practice Address - Phone:781-551-8002
Practice Address - Fax:781-551-8004
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA200876363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP1246Medicare ID - Type Unspecified