Provider Demographics
NPI:1689960312
Name:BROYLES, RYAN GABRIEL (AUD, CCC-A)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:GABRIEL
Last Name:BROYLES
Suffix:
Gender:M
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:KY
Mailing Address - Zip Code:42134-2113
Mailing Address - Country:US
Mailing Address - Phone:270-776-9905
Mailing Address - Fax:
Practice Address - Street 1:105 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:KY
Practice Address - Zip Code:42134-2113
Practice Address - Country:US
Practice Address - Phone:270-776-9905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1921231H00000X
KY168581237700000X
KY167959231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY167959OtherAUDIOLOGY LICENSE
KY7100403700Medicaid
TN1921OtherAUDIOLOGY LICENSE