Provider Demographics
NPI:1942272802
Name:RYALS, KATE GWENDOLYN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KATE
Middle Name:GWENDOLYN
Last Name:RYALS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:KATE
Other - Middle Name:GWENDOLYN
Other - Last Name:FOSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:560 AVENUE K SE
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-4203
Mailing Address - Country:US
Mailing Address - Phone:863-299-3376
Mailing Address - Fax:863-299-2830
Practice Address - Street 1:560 AVENUE K SE
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-4203
Practice Address - Country:US
Practice Address - Phone:863-299-3376
Practice Address - Fax:863-299-2830
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101883363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL29081600Medicaid
Q06959Medicare UPIN
U1983YMedicare ID - Type Unspecified