Healthcare Provider Details

I. General information

NPI: 1205411899
Provider Name (Legal Business Name): ADRIANNE BRYANT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2021
Last Update Date: 03/15/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 14TH AVE SW
SIDNEY MT
59270-3519
US

IV. Provider business mailing address

2346 3RD ST NW
SIDNEY MT
59270-5837
US

V. Phone/Fax

Practice location:
  • Phone: 406-488-2100
  • Fax:
Mailing address:
  • Phone: 303-819-7619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMED-PAC-LIC-96215
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: