Healthcare Provider Details

I. General information

NPI: 1720121114
Provider Name (Legal Business Name): ANNETTE C BRYANT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 NORTH 5TH STREET VA BLACK HILLS HCS
HOT SPRINGS SD
51747-0500
US

IV. Provider business mailing address

PO BOX 53
NEWELL SD
57760-0053
US

V. Phone/Fax

Practice location:
  • Phone: 605-745-2000
  • Fax:
Mailing address:
  • Phone: 605-490-3127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCP000464
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCP000464
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: