Healthcare Provider Details

I. General information

NPI: 1821609082
Provider Name (Legal Business Name): WILLIAM COLEMAN BRYANT FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2020
Last Update Date: 10/12/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5552 W LONGLEAF DR
SPRINGFIELD MO
65802-7834
US

IV. Provider business mailing address

PO BOX 802843
KANSAS CITY MO
64180-2843
US

V. Phone/Fax

Practice location:
  • Phone: 479-633-1244
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2020019159
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: