Provider Demographics
NPI:1932348463
Name:BRYANT, KELLIE DIONNE (DNP, WHNP-BC)
Entity Type:Individual
Prefix:DR
First Name:KELLIE
Middle Name:DIONNE
Last Name:BRYANT
Suffix:
Gender:F
Credentials:DNP, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6434 102ND ST
Mailing Address - Street 2:APT 3S
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-3650
Mailing Address - Country:US
Mailing Address - Phone:718-897-3725
Mailing Address - Fax:
Practice Address - Street 1:13303 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-2618
Practice Address - Country:US
Practice Address - Phone:718-291-3276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF420587-1374T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel