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1306451513
BRYANT THOMAS OVERSTREET
PRAIRIE VILLAGE, KS
NPI
1306451513
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
390200000X Student in an Organized Health Care Education/Training Program
(Licence: KS 3-111378)
Enumeration Date
2020-09-14
Last Update Date
2020-09-14
Business Address
BRYANT THOMAS OVERSTREET
4016 W 95TH ST
PRAIRIE VILLAGE, KS 66207-2702
Phone number: 913-307-3057
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Mailing Address
BRYANT THOMAS OVERSTREET
610 NE 66TH TER
GLADSTONE, MO 64118-3440
Phone number:
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