Healthcare Provider Details

I. General information

NPI: 1427461011
Provider Name (Legal Business Name): ABBY BRYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 06/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 FLANIGAN
AUGUSTA KS
67010
US

IV. Provider business mailing address

6 FLANIGAN
AUGUSTA KS
67010
US

V. Phone/Fax

Practice location:
  • Phone: 316-708-7233
  • Fax:
Mailing address:
  • Phone: 316-708-7233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333300000X
TaxonomyEmergency Response System Companies
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: