Healthcare Provider Details

I. General information

NPI: 1184333247
Provider Name (Legal Business Name): NELYANT INTEGRATED HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2022
Last Update Date: 07/05/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11225 N 28TH DR STE A102-19
PHOENIX AZ
85029-5606
US

IV. Provider business mailing address

PO BOX 6012
PHOENIX AZ
85005-6012
US

V. Phone/Fax

Practice location:
  • Phone: 806-414-8040
  • Fax: 602-654-6720
Mailing address:
  • Phone: 806-414-8040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. NELSON MCNOVA BRYANT
Title or Position: DIRECTOR OF MEDICAL OPERATIONS
Credential: PHD, FNP-C
Phone: 480-788-0240