Healthcare Provider Details

I. General information

NPI: 1275959215
Provider Name (Legal Business Name): MICHELLE BRANDY BRYANT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2014
Last Update Date: 08/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 N TOWNVILLE ST
SENECA SC
29678-2642
US

IV. Provider business mailing address

709 TALL OAK TRL
SENECA SC
29678-5049
US

V. Phone/Fax

Practice location:
  • Phone: 864-882-2245
  • Fax:
Mailing address:
  • Phone: 864-247-6672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95746
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18939
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: