Provider Demographics
NPI:1093123143
Name:RYAN, ALYSON (CPNP)
Entity Type:Individual
Prefix:
First Name:ALYSON
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1072
Mailing Address - Street 2:
Mailing Address - City:POTH
Mailing Address - State:TX
Mailing Address - Zip Code:78147-1072
Mailing Address - Country:US
Mailing Address - Phone:830-484-0320
Mailing Address - Fax:210-569-6488
Practice Address - Street 1:117 DILWORTH PLAZA
Practice Address - Street 2:
Practice Address - City:POTH
Practice Address - State:TX
Practice Address - Zip Code:78147
Practice Address - Country:US
Practice Address - Phone:830-484-0320
Practice Address - Fax:210-569-6488
Is Sole Proprietor?:No
Enumeration Date:2014-07-31
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP126571363LP0200X
TXRN540733163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse