Healthcare Provider Details

I. General information

NPI: 1942015060
Provider Name (Legal Business Name): KAYLA S BRYANT MSN, RN, CMGT-BC CCM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2025
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 8TH DIVISION RD
COLUMBIA SC
29207-5700
US

IV. Provider business mailing address

4500 8TH DIVISION RD
COLUMBIA SC
29207-5700
US

V. Phone/Fax

Practice location:
  • Phone: 803-751-0672
  • Fax:
Mailing address:
  • Phone: 803-751-0672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number216868
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: