Provider Demographics
NPI:1407548712
Name:RYAN, TIMMON HAYLEY (PA-C)
Entity Type:Individual
Prefix:
First Name:TIMMON
Middle Name:HAYLEY
Last Name:RYAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TIMMON
Other - Middle Name:HAYLEY
Other - Last Name:HERZBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2049 S CYPRESS CT
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207-5821
Mailing Address - Country:US
Mailing Address - Phone:316-617-8307
Mailing Address - Fax:
Practice Address - Street 1:761 W 175TH ST S
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:KS
Practice Address - Zip Code:67022-8301
Practice Address - Country:US
Practice Address - Phone:620-845-6492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-24
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical