Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 31275 | KY |
Y | 2080P0208X | Pediatric Infectious Diseases | 31275 | KY |
NPI | 1194709196 |
---|---|
Provider Name | Dr. Kristina Kruer Bryant |
First Address | Louisville, KY 40201-0909 |
Second Address | Louisville, KY 40202-3904 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2005 |
Last Update Date | 13/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200272740 | (05) | IN |
64011620 | (05) | KY |