Basic Information
| Provider Information | |||||||||
| NPI: | 1144204645 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRYANT | ||||||||
| FirstName: | DENISE | ||||||||
| MiddleName: | ABSHER | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 214 DOCTOR STREET | ||||||||
| Address2: | |||||||||
| City: | SPARTA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286759247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3363725606 | ||||||||
| FaxNumber: | 3363726211 | ||||||||
| Practice Location | |||||||||
| Address1: | 214 DOCTOR STREET | ||||||||
| Address2: | |||||||||
| City: | SPARTA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286759247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3363725606 | ||||||||
| FaxNumber: | 3363726211 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2005 | ||||||||
| LastUpdateDate: | 06/19/2013 | ||||||||
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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 | 207Q00000X | 200100112 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1144204645 | 05 | VA | MEDICAID | 8579815 | 01 | NC | CIGNA HEALTHCARE | OTHER | 129XF | 01 | NC | BLUE CROSS BLUE SHELD OF NORTH CAROLINA | OTHER | 89129XF | 05 | NC | MEDICAID | 238680 | 01 | VA | BLUE CROSS ANTHEM OF VIRGINIA | OTHER | 192454 | 01 | NC | MEDCOST | OTHER | 42366 | 01 | NC | PARTNERS | OTHER |