Provider Demographics
NPI:1619277803
Name:BRYANT, KATHY (CPNP, FNP-BC)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:BRYANT
Suffix:
Gender:F
Credentials:CPNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2808 FOX CHASE LN
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-4008
Mailing Address - Country:US
Mailing Address - Phone:804-303-9622
Mailing Address - Fax:
Practice Address - Street 1:2808 FOX CHASE LN
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-4008
Practice Address - Country:US
Practice Address - Phone:804-303-9622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-22
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024165996363LP0200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics