Provider Demographics
NPI:1548694557
Name:BRYNER, KENNETH (CNP)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:BRYNER
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13719 LORAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-3439
Mailing Address - Country:US
Mailing Address - Phone:216-307-3005
Mailing Address - Fax:216-710-5360
Practice Address - Street 1:13719 LORAIN AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-3439
Practice Address - Country:US
Practice Address - Phone:216-307-3005
Practice Address - Fax:216-710-5360
Is Sole Proprietor?:No
Enumeration Date:2013-08-27
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA-14982363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health