Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | ATP-000157 | AR |
NPI | 1720242241 |
---|---|
Provider Name | Latarsha A Bryant |
First Address | West Memphis, AR 72301-3550 |
Second Address | West Memphis, AR 72301-3550 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2008 |
Last Update Date | 04/11/2011 |