Provider Demographics
NPI:1477027019
Name:RYAN, KATHRYN ANNE (NP)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:ANNE
Last Name:RYAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:ANNE
Other - Last Name:BELISLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:37 BROAD COVE WOODS
Mailing Address - Street 2:
Mailing Address - City:YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04096-6162
Mailing Address - Country:US
Mailing Address - Phone:207-240-9997
Mailing Address - Fax:
Practice Address - Street 1:96 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-7163
Practice Address - Country:US
Practice Address - Phone:207-396-5617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-16
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP191236363LF0000X
CA95010858363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily