Provider Demographics
NPI:1447444922
Name:BRYAN, TERESA LOWERY (CFNP)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:LOWERY
Last Name:BRYAN
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CAMPUS DR
Mailing Address - Street 2:P. O. BOX 18399
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-5364
Mailing Address - Country:US
Mailing Address - Phone:601-304-4300
Mailing Address - Fax:601-304-4398
Practice Address - Street 1:15 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-5364
Practice Address - Country:US
Practice Address - Phone:601-304-4300
Practice Address - Fax:601-304-4398
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR626805363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily