Provider Demographics
NPI:1508187873
Name:GAMBINO, RYAN ELIZABETH (PA)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:ELIZABETH
Last Name:GAMBINO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:RYAN
Other - Middle Name:ELIZABETH
Other - Last Name:BOYKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2790 CLAY EDWARDS DR STE 520
Mailing Address - Street 2:
Mailing Address - City:NORTH KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3274
Mailing Address - Country:US
Mailing Address - Phone:816-691-5198
Mailing Address - Fax:816-346-7095
Practice Address - Street 1:2790 CLAY EDWARDS DR STE 520
Practice Address - Street 2:
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3274
Practice Address - Country:US
Practice Address - Phone:816-691-5198
Practice Address - Fax:816-346-7095
Is Sole Proprietor?:No
Enumeration Date:2010-06-21
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-02332363A00000X
COPA.0004286363A00000X
MO2022012973363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO86756834Medicaid