Marshalvia Bryant, NP
Individual provider Active NPI Primary Care Nurse Practitioner · Greenville, MS
NPI 1083366975 · NPPES record last updated Apr 6, 2022
Key facts
- NPI
- 1083366975
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Primary Care Nurse Practitioner 363LP2300X
- License
- 905124 (MS)
- Practice address
- 1221 E Union St
Greenville, MS 38703-3243 - Phone
- (731) 394-1145
- NPI assigned
- Jan 21, 2022
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 18
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- G a Carmichael Family Health Center, Inc.
Practice addresses (Care Compare)
200 Grand Blvd
Greenwood, MS 38930-3504
Phone (601) 859-5213
Hospital & facility affiliations
- Greenwood Leflore Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220414001514 | MS | Practitioner - Nurse Practitioner | 3274929484 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 905124 | MS | MD | Primary Care Nurse Practitioner |
Practice roles (5 of 6)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| State of Mississippi - University of Mississippi Medical Center | Current |
Accepting new patients | |
| G a Carmichael Family Health Center Inc | Current |
Accepting new patients | |
| G a Carmichael Family Health Center, Inc | Current |
Accepting new patients | |
| Greenwood Leflore Hospital | Current |
Accepting new patients | |
| G a Carmichael Family Health Center. Inc. | Past | Accepting new patients |
Locations
1668 W Peace St
Canton, MS 39046
Phone (601) 859-0050
1413 Strong Ave
Greenwood, MS 38930
Phone (662) 459-1207
1401 River Rd
Greenwood, MS 38930
Phone (662) 459-2603
Networks
- LA PPO C-SNP
Interoperability endpoints
- marshalvia.bryant.p1@direct.gacfhc.nextgenshare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Nurse Practitioner | 363LP2300X | 905124 | MS | Yes |
Addresses
Primary practice location
1221 E Union St
Greenville, MS 38703-3243
Mailing address
406 Martin St
Greenwood, MS 38930-3436
Phone (662) 361-8897
Other providers in Greenville, MS
- David Van Broome
- Claire Brown
- David Brown
- Brown'S Main Street Pharmacy Inc.
- William Brozovich
- Ethel Buckner
- Tomie C. Burdine
- Richard Burks
- Burton Medical Center, Inc.
- Charles Henry Burton Jr.
All providers in Greenville, MS · Primary Care Nurse Practitioner in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 6, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.