Healthcare Provider Details

I. General information

NPI: 1700772001
Provider Name (Legal Business Name): JORDIAN BRYANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 06/16/2025
Certification Date: 06/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 E CLAY ST
RICHMOND VA
23298-5071
US

IV. Provider business mailing address

6507 WOODLAKE VILLAGE CT APT E
MIDLOTHIAN VA
23112-2216
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-9000
  • Fax:
Mailing address:
  • Phone: 804-316-3108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number0001331662
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: