Provider Demographics
NPI:1043611957
Name:WILLIAMS, RYAN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:RYAN
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 E DESERT INN RD
Mailing Address - Street 2:STE 100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-3609
Mailing Address - Country:US
Mailing Address - Phone:702-731-1616
Mailing Address - Fax:702-734-4900
Practice Address - Street 1:2800 E DESERT INN RD
Practice Address - Street 2:STE 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-3609
Practice Address - Country:US
Practice Address - Phone:702-731-1616
Practice Address - Fax:702-734-4900
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA1573363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1043611957Medicaid
NV1043611957Medicaid