=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093619231
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANNY MELOYD BRYANT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2026
-----------------------------------------------------
Last Update Date | 10/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4222 HIGHWAY 830
-----------------------------------------------------
City | GRAY
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40734-4511
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-528-9601
-----------------------------------------------------
Fax | 606-277-0647
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4222 HIGHWAY 830
-----------------------------------------------------
City | GRAY
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40734-4511
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-528-9601
-----------------------------------------------------
Fax | 606-277-0647
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 175T00000X
-----------------------------------------------------
Taxonomy Name | Peer Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------