Provider Demographics
NPI:1487971115
Name:BRYANT, KRISTE
Entity type:Individual
Prefix:
First Name:KRISTE
Middle Name:
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:PO BOX 245
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:AR
Mailing Address - Zip Code:72556-0245
Mailing Address - Country:US
Mailing Address - Phone:870-300-2112
Mailing Address - Fax:844-377-1447
Practice Address - Street 1:31 SCHOOL DR STE B
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:AR
Practice Address - Zip Code:72556-8620
Practice Address - Country:US
Practice Address - Phone:870-300-2112
Practice Address - Fax:844-377-1447
Is Sole Proprietor?:No
Enumeration Date:2010-04-20
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR7659-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical