Healthcare Provider Details

I. General information

NPI: 1538622378
Provider Name (Legal Business Name): ASHLEY BRYANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2019
Last Update Date: 04/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5604 COLISEUM BLVD STE A
ALEXANDRIA LA
71303-3993
US

IV. Provider business mailing address

5604 COLISEUM BLVD STE A
ALEXANDRIA LA
71303-3993
US

V. Phone/Fax

Practice location:
  • Phone: 318-487-5282
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN113810
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: