Healthcare Provider Details

I. General information

NPI: 1780529792
Provider Name (Legal Business Name): SARAH GRACE BRYANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 ALMOND TREE LN
CLOVIS NM
88101-1718
US

IV. Provider business mailing address

505 ALMOND TREE LN
CLOVIS NM
88101-1718
US

V. Phone/Fax

Practice location:
  • Phone: 910-986-8315
  • Fax:
Mailing address:
  • Phone: 910-986-8315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9568297
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: