MEDICARE: KEVIN MICHAEL BRYANT APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	71015653A	IN

General Provider Information

NPI Number	:	1689406357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN MICHAEL BRYANT APRN

Provider Business Mailing Address
First Line	:	26 KINCRAIG DR
Second Line	:
City	:	VALPARAISO
State	:	IN
Zip	:	46385-9290
Country	:	US
Telephone Number	:	219-405-9302
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 ALFRED ST
Second Line	:
City	:	MICHIGAN CITY
State	:	IN
Zip	:	46360-7303
Country	:	US
Telephone Number	:	219-872-6200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2024
Last Update Date	:	08/20/2024

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