Basic Information
| Provider Information | |||||||||
| NPI: | 1083654073 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRYAN | ||||||||
| FirstName: | DARLA | ||||||||
| MiddleName: | JEAN | ||||||||
| NamePrefix: | |||||||||
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| Credential: | RN, CS, ANP | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | BRYAN | ||||||||
| OtherFirstName: | DARLA | ||||||||
| OtherMiddleName: | JEAN | ||||||||
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| OtherCredential: | APRN | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 937 JUSTICE CT | ||||||||
| Address2: | |||||||||
| City: | FLORISSANT | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630342050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3148373204 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 621 S NEW BALLAS RD | ||||||||
| Address2: | SUITE 30163 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631418232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3142516339 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2006 | ||||||||
| LastUpdateDate: | 07/14/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 085975 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.