Provider Demographics
NPI:1265021919
Name:KENT, RYAN DANIEL (FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:DANIEL
Last Name:KENT
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 E KENDALL DR STE C
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-1921
Mailing Address - Country:US
Mailing Address - Phone:630-385-2360
Mailing Address - Fax:
Practice Address - Street 1:520 E KENDALL DR STE C
Practice Address - Street 2:
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-1921
Practice Address - Country:US
Practice Address - Phone:630-385-2360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-15
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209022150363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily