Provider Demographics
NPI:1407322670
Name:RYAN, JESSICA DIANE MCKEOWN (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:DIANE MCKEOWN
Last Name:RYAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18313 PAULSON ST SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:WA
Mailing Address - Zip Code:98579-9262
Mailing Address - Country:US
Mailing Address - Phone:360-827-8400
Mailing Address - Fax:360-273-7301
Practice Address - Street 1:18313 PAULSON ST SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:WA
Practice Address - Zip Code:98579-9262
Practice Address - Country:US
Practice Address - Phone:360-827-8400
Practice Address - Fax:360-273-7301
Is Sole Proprietor?:No
Enumeration Date:2018-10-15
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60909311363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily