Healthcare Provider Details

I. General information

NPI: 1033047519
Provider Name (Legal Business Name): ABBY A BRYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 N. WASHINGTON DURANT
DURANT OK
74701
US

IV. Provider business mailing address

980 S COIT RD APT 1331
PROSPER TX
75078-3003
US

V. Phone/Fax

Practice location:
  • Phone: 580-706-6939
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-478337
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: