Individual
JENNIFER FUQUA BRYANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
5875 N MAJOR DR, BEAUMONT, TX 77713-9034
(409) 892-2262
(409) 892-3336
Mailing address
919 HIDDEN RDG, IRVING, TX 75038-3813
(469) 282-2711
(469) 282-0996
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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