MEDICARE: GINA BRYANT NP

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	A004921	AR

General Provider Information

NPI Number	:	1487104907
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA BRYANT NP

Provider Business Mailing Address
First Line	:	1 MERCY LN STE 304
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71913-6440
Country	:	US
Telephone Number	:	501-321-4772
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 MERCY LN STE 304
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71913-6440
Country	:	US
Telephone Number	:	501-321-4772
Fax Number	:

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

Provider Enumeration Date	:	10/07/2016
Last Update Date	:	10/07/2016

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