Healthcare Provider Details

I. General information

NPI: 1497948129
Provider Name (Legal Business Name): NATALIE GAYLE BRYANT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2007
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

928 N GLENWOOD BLVD
TYLER TX
75702
US

IV. Provider business mailing address

PO BOX 844273
DALLAS TX
75284-4273
US

V. Phone/Fax

Practice location:
  • Phone: 903-535-9041
  • Fax:
Mailing address:
  • Phone: 903-535-9041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP125713
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN152834
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number853818
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: