Provider Demographics
NPI:1609426071
Name:ZUBER, RYAN FRED ALEX (PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:FRED ALEX
Last Name:ZUBER
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 ASCHAM CT.
Mailing Address - Street 2:HENDERSON ROAD
Mailing Address - City:PEARL
Mailing Address - State:MS
Mailing Address - Zip Code:39208-9361
Mailing Address - Country:US
Mailing Address - Phone:601-966-1977
Mailing Address - Fax:
Practice Address - Street 1:1500 E WOODROW WILSON AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-5116
Practice Address - Country:US
Practice Address - Phone:601-362-4471
Practice Address - Fax:601-368-3904
Is Sole Proprietor?:No
Enumeration Date:2019-09-17
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903437363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health