Provider Demographics
NPI:1184634743
Name:RYDER, JULIE J (PMHNP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:J
Last Name:RYDER
Suffix:
Gender:F
Credentials:PMHNP
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 1359
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-0075
Mailing Address - Country:US
Mailing Address - Phone:541-882-1540
Mailing Address - Fax:
Practice Address - Street 1:409 PINE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-6020
Practice Address - Country:US
Practice Address - Phone:541-273-0515
Practice Address - Fax:541-727-0482
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200750026NPPMHNPPP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP01093314OtherRR MEDICARE
ORR165122OtherMEDICARE PTAN
OR218345Medicaid
ORQ53884Medicare UPIN