Provider Demographics
NPI:1912183500
Name:MISSI, RYAN M (APRN-BC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:M
Last Name:MISSI
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:MERIDETH
Other - Middle Name:M
Other - Last Name:MISSI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:207 SPARKS AVE
Mailing Address - Street 2:STE 403
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3739
Mailing Address - Country:US
Mailing Address - Phone:812-288-9141
Mailing Address - Fax:812-288-1023
Practice Address - Street 1:207 SPARKS AVE
Practice Address - Street 2:STE 403
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3739
Practice Address - Country:US
Practice Address - Phone:812-288-9141
Practice Address - Fax:812-288-1023
Is Sole Proprietor?:No
Enumeration Date:2008-01-14
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002582A363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics