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Individual
JENNIFER FUQUA BRYANT
Active
Individual
JENNIFER FUQUA BRYANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP120592
TX
363LA2200X
Adult Health Nurse Practitioner
687943
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1K1805
MEDICARE
TX
05
—
331662202
—
TX
01
—
P02601517
MCRR
TX
Enumeration date
08/30/2012
Last updated
04/12/2021
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