Healthcare Provider Details

I. General information

NPI: 1982569661
Provider Name (Legal Business Name): KAELA ELAINE BRYANT MSRS, RRA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 LAKELAND HILLS BLVD
LAKELAND FL
33805-3019
US

IV. Provider business mailing address

10 GREENTREE ST
HOMOSASSA FL
34446-5101
US

V. Phone/Fax

Practice location:
  • Phone: 863-680-7786
  • Fax:
Mailing address:
  • Phone: 352-942-9111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number90312
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code243U00000X
TaxonomyRadiology Practitioner Assistant
License Number180
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: