Jill L Bryant Aprn LLC
Organization Active NPI Family Nurse Practitioner · Williamsburg, KY
NPI 1669891966 · NPPES record last updated Apr 15, 2014
Key facts
- NPI
- 1669891966
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 3006489 (KY)
- Legal business name
- JILL L BRYANT APRN LLC
- Practice address
- 406 N Highway 25 W
Williamsburg, KY 40769-1545 - Phone
- (606) 521-0071
- NPI assigned
- Apr 15, 2014
- Organization subpart
- No
Authorized official
- Name
- Jill L Bryant
- Title
- Nurse Practitioner
- Phone
- (606) 521-0071
Owners & managing parties with NPI records 1
-
Jill L Bryant, APRN
Practitioners 10
-
Jill L Bryant, APRN
-
Rhonda Hacker, APRN-PMHNP
-
Carolyn F McFarland, APRN, FNP, PMHNP-BC
-
Chasity Lee Prewitt, LPCA
-
Shonda Lynn Tucker, APRN
-
Eddie Steely Perkins, D.O.
-
Heather Marie Hammack, APRN, FNP-C
-
Joyce A Parker, APRN, NP-C
-
Sheryl Partin, NP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 18D2082758 | Jill Bryant Aprn LLC | Certificate of waiver | Aug 20, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in KY
Rural health clinic certification: CCN 188946
- Legal name
- JILL L BRYANT APRN LLC
- Doing business as
- BRYANT FAMILY MEDICINE
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Jul 16, 2015
- Last certification
- Jul 16, 2015
- Ownership / control type
- 1A
- Organization structure
- LLC · Proprietary
- Incorporated
- Feb 5, 2014 in KY
- Enrollment address
- 3277 N Highway 25 W
Williamsburg, KY 40769-8699
All disclosed owners & managing parties 1
| Name | Role | Since | Share |
|---|---|---|---|
| Jill L Bryant |
5% Or Greater Direct Ownership Interest | Apr 1, 2014 | 100% |
| Corporate Officer |
Jan 1, 2022 | 100% | |
| W-2 Managing Employee |
Jan 1, 2022 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20140623001663 | KY | Part B Supplier - Clinic/Group Practice | 4789808387 |
Receives reassigned benefits from 6 practitioners Practice locations: Williamsburg, KY |
| O20150417001292 | KY | Part a Provider - Rural Health Clinic | 4789808387 | Practice locations: Williamsburg, KY |
National Provider Directory
Locations
998 S Highway 25 W
Williamsburg, KY 40769
Phone (606) 539-7257
2932 N Highway 25 W
Williamsburg, KY 40769
Phone (606) 515-6051
3277 N Highway 25 W
Williamsburg, KY 40769
Phone (606) 549-8088
2932 N Highway 25 W
#1
Williamsburg, KY 40769
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner |
363LF0000X | 3006489 | KY | Yes |
Addresses
Primary practice location
406 N Highway 25 W
Williamsburg, KY 40769-1545
Mailing address
980 Old Corbin Pike Rd
Williamsburg, KY 40769-2099
Phone (606) 521-0071
Other providers in Williamsburg, KY
- Kenneth Ho
- Hope Primary & Urgent Care of Williamsburg PLLC
- John A Jeffries
- Jellico Community Hospital, Inc
- Jellico Regional Hospital, LLC
- Anna Vimala John
- Marcie Leigh Johnson
- Josalynn Jones
- Julie Marie Jones
- Kimberly K Jones
All providers in Williamsburg, KY · Family Nurse Practitioner in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 15, 2014. 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.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- 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.