MEDICARE: ANITA 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
1	363LF0000X	Family Nurse Practitioner	83161	OK

General Provider Information

NPI Number	:	1891353967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANITA BRYANT

Provider Business Mailing Address
First Line	:	3013 AZALEA PARK DR
Second Line	:
City	:	MUSKOGEE
State	:	OK
Zip	:	74401-2285
Country	:	US
Telephone Number	:	918-201-9750
Fax Number	:	918-201-9750

Provider Business Practice Location Address
First Line	:	110 W MARTIN LUTHER KING ST
Second Line	:
City	:	MUSKOGEE
State	:	OK
Zip	:	74401-3351
Country	:	US
Telephone Number	:	918-682-0222
Fax Number	:	918-682-0221

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

Provider Enumeration Date	:	06/03/2019
Last Update Date	:	03/02/2026

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Directions to “ ANITA BRYANT ” Practice Location

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