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NPI Code Detail

MEDICARE: AMY LOCKLEAR BRYANT RN

MEDICARE: AMY LOCKLEAR BRYANT RN
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
1253Z00000XIn Home Supportive Care AgencyHC3907NC

General Provider Information

NPI Number : 1710483953
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY LOCKLEAR BRYANT RN
Provider Business Mailing Address
First Line : 110 N PATTERSON ST
Second Line :
City : MAXTON
State : NC
Zip : 28364-1735
Country : US
Telephone Number : 910-774-6078
Fax Number :
Provider Business Practice Location Address
First Line : 110 N PATTERSON ST
Second Line :
City : MAXTON
State : NC
Zip : 28364-1735
Country : US
Telephone Number : 910-774-6078
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2018
Last Update Date : 04/05/2018

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