Kelly Dean Bryan, LMSW, CAC-I

Primary specialty

Social WorkerTaxonomy code 104100000X

License

6801077320 Issued in MI

Practice address

6379 Dixie Hwy
Bridgeport, MI 48722-9566

Phone

(989) 777-4357

Fax

(989) 777-7257

NPI assigned

Mar 2, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bay-Arenac Behavioral Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Bay City, MI
  • NPI 1154439438
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1144359795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1402 WOODSIDE AVE",
            "city": "BAY CITY",
            "state": "MI",
            "postal_code": "487085478",
            "telephone_number": "989-895-5049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6379 DIXIE HWY",
            "city": "BRIDGEPORT",
            "state": "MI",
            "postal_code": "487229566",
            "telephone_number": "989-777-4357",
            "fax_number": "989-777-7257"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRYAN",
        "first_name": "KELLY",
        "middle_name": "DEAN",
        "name_prefix": "Mrs.",
        "credential": "LMSW, CAC-I",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6801077320",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PLUS OF MICHIGAN",
            "identifier": "0996611",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCLAREN",
            "identifier": "1021439",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nickolis Wyatt Brooks
• Jordynn Browb
• Emily Jayne Bruce
• Lee Ann Brummett, BA
• Kayla Jo Brunner
• Jacquavious Deshawn Burt
• Abigail Cadle
• Tavey Adele Campbell
• Juanita Canty
• Kimberly Lynn Carrick

• Social Worker in Bridgeport, MI
• Providers in Bridgeport, MI by specialty
• Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.