Provider Demographics
NPI:1114151297
Name:DRYE, C RONALD (MNSC)
Entity Type:Individual
Prefix:
First Name:C
Middle Name:RONALD
Last Name:DRYE
Suffix:
Gender:M
Credentials:MNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 RICHMOND RD # 281
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-2123
Mailing Address - Country:US
Mailing Address - Phone:903-792-2991
Mailing Address - Fax:903-792-2996
Practice Address - Street 1:2014 GALLERIA OAKS DR
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-4620
Practice Address - Country:US
Practice Address - Phone:903-792-2991
Practice Address - Fax:903-792-2996
Is Sole Proprietor?:No
Enumeration Date:2009-05-05
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR287955363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology