1023641230 NPI number — KRYSTAIN TAYLORE BRYANT B.S IN PSYCHOLOGY

Table of content: KRYSTAIN TAYLORE BRYANT B.S IN PSYCHOLOGY (NPI 1023641230)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023641230 NPI number — KRYSTAIN TAYLORE BRYANT B.S IN PSYCHOLOGY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRYANT
Provider First Name:
KRYSTAIN
Provider Middle Name:
TAYLORE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
B.S IN PSYCHOLOGY
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023641230
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/27/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1500 S DOUGLAS RD STE 230
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORAL GABLES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33134-4108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
844-854-1116
Provider Business Mailing Address Fax Number:
305-846-9711

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3351 ASPEN GROVE DR STE 350
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRANKLIN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37067-2912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
844-854-1116
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/16/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
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Provider Taxonomy Codes

  • Taxonomy code: 106S00000X , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)