Healthcare Provider Details

I. General information

NPI: 1730381765
Provider Name (Legal Business Name): CARRIE ALICEA BRYSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 03/24/2024
Certification Date: 03/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11908 HARRIS POINTE DR
CHARLOTTE NC
28269-1253
US

IV. Provider business mailing address

9711 DAVID TAYLOR DR STE 141
CHARLOTTE NC
28262-2366
US

V. Phone/Fax

Practice location:
  • Phone: 980-320-6545
  • Fax:
Mailing address:
  • Phone: 980-320-6545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number362801
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: