Healthcare Provider Details

I. General information

NPI: 1952630824
Provider Name (Legal Business Name): SHIRLEY BRYANT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2009
Last Update Date: 12/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E BROOKLYN ST
LINDEN TN
37096-3515
US

IV. Provider business mailing address

PO BOX 916
LINDEN TN
37096-0916
US

V. Phone/Fax

Practice location:
  • Phone: 931-589-2104
  • Fax: 931-589-2513
Mailing address:
  • Phone: 931-589-2104
  • Fax: 931-589-2513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN 14198
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: