Provider Demographics
NPI:1356829147
Name:FAULKNER, RYAN THOMAS (APRN)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:THOMAS
Last Name:FAULKNER
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1595
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-1595
Mailing Address - Country:US
Mailing Address - Phone:606-408-6200
Mailing Address - Fax:606-408-6612
Practice Address - Street 1:4004 LOUISA RD
Practice Address - Street 2:
Practice Address - City:CATLETTSBURG
Practice Address - State:KY
Practice Address - Zip Code:41129
Practice Address - Country:US
Practice Address - Phone:606-739-6095
Practice Address - Fax:606-739-8252
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3012580363LF0000X
OHAPRN.CNP.023474363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily