Provider Demographics
NPI:1770039356
Name:WHITE, RYAN
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:WHITE
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 1:1664 S DIXIE DR STE E102
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-7329
Mailing Address - Country:US
Mailing Address - Phone:435-703-9647
Mailing Address - Fax:435-703-6003
Practice Address - Street 1:1789 N WEDGEWOOD LN STE 1
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84721-7769
Practice Address - Country:US
Practice Address - Phone:435-703-9647
Practice Address - Fax:435-703-6003
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7996304-4405363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily