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NPI Code Detail

MEDICARE: GRACE BRYANT

MEDICARE: GRACE BRYANT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1316870629
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRACE BRYANT
Provider Business Mailing Address
First Line : 2264 LOOKOUT MOUNTAIN RD
Second Line :
City : BENTON
State : AR
Zip : 72019-7808
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4301 W MARKHAM ST
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72205-7101
Country : US
Telephone Number : 501-686-8000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2026
Last Update Date : 06/05/2026

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Directions to “ GRACE BRYANT ” Practice Location

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