Healthcare Provider Details

I. General information

NPI: 1205308418
Provider Name (Legal Business Name): PATRICIA NICOLE BRYAN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2018
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1426 E MAIN ST
ALBEMARLE NC
28001-5236
US

IV. Provider business mailing address

3211 RUNNEYMEDE ST SW
CONCORD NC
28027-2723
US

V. Phone/Fax

Practice location:
  • Phone: 704-982-0950
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberBRYA-0P7MX2
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: