Provider Demographics
NPI:1043411374
Name:RYALL, KRISTINE (APRN MSN FNPC)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:RYALL
Suffix:
Gender:F
Credentials:APRN MSN FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 DATA DR 1ST
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:916-379-2726
Mailing Address - Fax:916-853-7874
Practice Address - Street 1:17051 SIERRA LAKES PKWY
Practice Address - Street 2:STE 101
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-1274
Practice Address - Country:US
Practice Address - Phone:909-428-2040
Practice Address - Fax:909-428-2191
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP9750363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily