Provider Demographics
NPI:1114109048
Name:SIMS, RYAN C (CRNA)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:C
Last Name:SIMS
Suffix:
Gender:M
Credentials:CRNA
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:146 MEDICAL PARK RD
Mailing Address - Street 2:STE 108
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8529
Mailing Address - Country:US
Mailing Address - Phone:704-662-0877
Mailing Address - Fax:704-662-0875
Practice Address - Street 1:131 MEDICAL PARK RD STE 308
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8525
Practice Address - Country:US
Practice Address - Phone:704-662-0876
Practice Address - Fax:704-662-0875
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2021-11-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OHRN275187367500000X
NC243429367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered