Provider Demographics
NPI:1548694169
Name:BRYANT, PAMELA CARTER (FNP-C)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:CARTER
Last Name:BRYANT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4857 HUNTINGTON DR N
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90032-1939
Mailing Address - Country:US
Mailing Address - Phone:323-226-9042
Mailing Address - Fax:323-226-9426
Practice Address - Street 1:4857 HUNTINGTON DR N
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90032-1939
Practice Address - Country:US
Practice Address - Phone:323-226-9042
Practice Address - Fax:323-226-9426
Is Sole Proprietor?:No
Enumeration Date:2013-08-30
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22641363LF0000X
CA382641163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA22641OtherLICENSE