Provider Demographics
NPI:1558865022
Name:RYAN, KATE ERIN (DO)
Entity Type:Individual
Prefix:DR
First Name:KATE
Middle Name:ERIN
Last Name:RYAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 T B STANLEY HWY
Mailing Address - Street 2:
Mailing Address - City:BASSETT
Mailing Address - State:VA
Mailing Address - Zip Code:24055-6108
Mailing Address - Country:US
Mailing Address - Phone:276-629-1076
Mailing Address - Fax:276-629-2695
Practice Address - Street 1:324 T B STANLEY HWY
Practice Address - Street 2:
Practice Address - City:BASSETT
Practice Address - State:VA
Practice Address - Zip Code:24055-6108
Practice Address - Country:US
Practice Address - Phone:276-629-1076
Practice Address - Fax:276-629-2695
Is Sole Proprietor?:No
Enumeration Date:2018-03-20
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102206721207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program