Doctor Name: | KATHLEEN RYAN |
NPI Number: | 1245372622 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APN |
License Number: | 254355 |
Business Practice Address: | 6907 Ellis Ct Apt C 6907 C Fort Polk, LA - 714593123 |
Business Phone Number: | 3372811040 |
Business Fax Number: | |
Mailing Address: | 6907 Ellis Ct Apt C, 6907 C FORT POLK |
State: | LA |
Postal Code: | 714593123 |
Phone Number: | 3372811040 |
Fax Number: | |
NPI Enumeration Date: | 02/13/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LA2200X |
License Number: | 254355 |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | TX |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Adult Health |
Taxonomy Definition: |