Provider Demographics
NPI:1790405272
Name:BALSLEY, RYAN DANIELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:DANIELLE
Last Name:BALSLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 FM 548 STE 100
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-6985
Mailing Address - Country:US
Mailing Address - Phone:972-564-0044
Mailing Address - Fax:
Practice Address - Street 1:375 FM 548 STE 100
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-6985
Practice Address - Country:US
Practice Address - Phone:972-564-0044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-02
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA15962363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant