Provider Demographics
NPI:1336503929
Name:RYDER, VERONICA MICHELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:MICHELLE
Last Name:RYDER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:VERONICA
Other - Middle Name:MICHELLE
Other - Last Name:ALANIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6200 ROTHWAY ST STE 160
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77040-5063
Mailing Address - Country:US
Mailing Address - Phone:713-779-5494
Mailing Address - Fax:
Practice Address - Street 1:6200 ROTHWAY ST STE 160
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77040-5063
Practice Address - Country:US
Practice Address - Phone:713-779-5494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-08
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA10455363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant