Provider Demographics
NPI:1225146327
Name:RYAN, KEVIN JAMES (CRNA)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:JAMES
Last Name:RYAN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 W RIVER RD
Mailing Address - Street 2:
Mailing Address - City:WORLAND
Mailing Address - State:WY
Mailing Address - Zip Code:82401-9747
Mailing Address - Country:US
Mailing Address - Phone:307-347-3204
Mailing Address - Fax:307-864-5039
Practice Address - Street 1:150 E ARAPAHOE ST
Practice Address - Street 2:HOT SPRINGS COUNTY MEMORIAL HOSPITAL
Practice Address - City:THERMOPOLIS
Practice Address - State:WY
Practice Address - Zip Code:82443-2402
Practice Address - Country:US
Practice Address - Phone:307-864-5023
Practice Address - Fax:307-864-5039
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY16571.0656367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY314292OtherBLUE CROSS/ BLUE SHIELD
WY115234300Medicaid
WYW23137Medicare PIN