Provider Demographics
NPI:1316371586
Name:BINGHAM, RYAN DAN (FPMHNP)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:DAN
Last Name:BINGHAM
Suffix:
Gender:M
Credentials:FPMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3644 W HIGHWAY 80
Mailing Address - Street 2:
Mailing Address - City:BISBEE
Mailing Address - State:AZ
Mailing Address - Zip Code:85603-6012
Mailing Address - Country:US
Mailing Address - Phone:801-885-4765
Mailing Address - Fax:520-432-2098
Practice Address - Street 1:101 COLE AVE
Practice Address - Street 2:
Practice Address - City:BISBEE
Practice Address - State:AZ
Practice Address - Zip Code:85603-1327
Practice Address - Country:US
Practice Address - Phone:520-432-2042
Practice Address - Fax:520-432-2098
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP5161363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health