Provider Demographics
NPI:1659776631
Name:KING, RYAN
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:KING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 TENNESSEE ST
Mailing Address - Street 2:UNIT 4
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-2901
Mailing Address - Country:US
Mailing Address - Phone:402-990-1207
Mailing Address - Fax:
Practice Address - Street 1:1106 N 155TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:BASEHOR
Practice Address - State:KS
Practice Address - Zip Code:66007-7100
Practice Address - Country:US
Practice Address - Phone:913-662-7071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-03
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator