Provider Demographics
NPI:1235571910
Name:RYAN, MICHAEL (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:RYAN
Suffix:
Gender:M
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 E BANDERA RD
Mailing Address - Street 2:STE 102
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-2849
Mailing Address - Country:US
Mailing Address - Phone:830-816-2312
Mailing Address - Fax:830-816-2349
Practice Address - Street 1:124 E BANDERA RD
Practice Address - Street 2:STE 102
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-2849
Practice Address - Country:US
Practice Address - Phone:830-816-2312
Practice Address - Fax:830-816-2349
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-23
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX596705363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX391321YLPSOtherWELLMED MEDICARE
TX3436990-01OtherWELLMED MEDICAID