Basic Information
| Provider Information | |||||||||
| NPI: | 1710451406 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRYANT | ||||||||
| FirstName: | MAYAH | ||||||||
| MiddleName: | ROBYN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8450 WEA ST | ||||||||
| Address2: | |||||||||
| City: | DE SOTO | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660188378 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9132153373 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7001 W 79TH ST | ||||||||
| Address2: | |||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662043179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8168026969 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2019 | ||||||||
| LastUpdateDate: | 01/15/2019 | ||||||||
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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 | 106S00000X | Y |
No ID Information.