Healthcare Provider Details

I. General information

NPI: 1447583885
Provider Name (Legal Business Name): KRIS BRYAN APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2009
Last Update Date: 03/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 W OAK ST SUITE 200
EL DORADO AR
71730-4586
US

IV. Provider business mailing address

5745 JUNCTION CITY HWY
EL DORADO AR
71730-8754
US

V. Phone/Fax

Practice location:
  • Phone: 870-875-5500
  • Fax:
Mailing address:
  • Phone: 318-465-1795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberA03266
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: