Provider Demographics
NPI:1265287932
Name:BRYANT, KIMBERLY FAYE
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:FAYE
Last Name:BRYANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:766 E HANLEY RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44903-7323
Mailing Address - Country:US
Mailing Address - Phone:419-295-0724
Mailing Address - Fax:
Practice Address - Street 1:259 S LINDEN RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-3031
Practice Address - Country:US
Practice Address - Phone:419-545-0290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty