Provider Demographics
NPI:1235512252
Name:REEB, RYAN (AGNP-BC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:REEB
Suffix:
Gender:M
Credentials:AGNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18074 DERBES DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-0337
Mailing Address - Country:US
Mailing Address - Phone:702-379-5315
Mailing Address - Fax:
Practice Address - Street 1:60491 DOSS DR STE D
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70460-4972
Practice Address - Country:US
Practice Address - Phone:985-690-6920
Practice Address - Fax:985-690-6933
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-08
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP08244363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology