Provider Demographics
NPI:1952836884
Name:FORD, RYAN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:FORD
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3018 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46615-1848
Mailing Address - Country:US
Mailing Address - Phone:574-299-3386
Mailing Address - Fax:
Practice Address - Street 1:2845 W CLEVELAND ROAD EXT
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46628-6188
Practice Address - Country:US
Practice Address - Phone:574-301-8800
Practice Address - Fax:574-371-2448
Is Sole Proprietor?:No
Enumeration Date:2017-04-28
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71007058A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner