Healthcare Provider Details

I. General information

NPI: 1083366975
Provider Name (Legal Business Name): MARSHALVIA BRYANT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2022
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 MARTIN ST
GREENWOOD MS
38930-3436
US

IV. Provider business mailing address

406 MARTIN ST
GREENWOOD MS
38930-3436
US

V. Phone/Fax

Practice location:
  • Phone: 662-361-8897
  • Fax:
Mailing address:
  • Phone: 662-361-8897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number905124
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: