MEDICARE: KATELYN LEE BRYANT APRN

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
1	363L00000X	Nurse Practitioner	APRN9292384	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417297854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATELYN LEE BRYANT APRN

Provider Business Mailing Address
First Line	:	710 OTIS RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32220-2942
Country	:	US
Telephone Number	:	904-400-0120
Fax Number	:

Provider Business Practice Location Address
First Line	:	8110 BLANDING BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-5823
Country	:	US
Telephone Number	:	904-400-0120
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2013
Last Update Date	:	03/14/2022

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