Healthcare Provider Details

I. General information

NPI: 1902684012
Provider Name (Legal Business Name): MEGAN BRYANT BUSBY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MEGAN RUTH BRYANT NP

II. Dates (important events)

Enumeration Date: 09/19/2023
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5675 THREE NOTCH RD
MOBILE AL
36619-1617
US

IV. Provider business mailing address

5675 THREE NOTCH RD
MOBILE AL
36619-1617
US

V. Phone/Fax

Practice location:
  • Phone: 251-445-4440
  • Fax: 251-445-4435
Mailing address:
  • Phone: 251-445-4440
  • Fax: 251-445-4435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1-202395
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number905699
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: