Provider Demographics
NPI:1972291938
Name:WILLIAMS, RYAN WALLINGFORD (PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:WALLINGFORD
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 W EDGEMONT AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85007-1113
Mailing Address - Country:US
Mailing Address - Phone:216-926-8295
Mailing Address - Fax:
Practice Address - Street 1:10901 E MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85256-5300
Practice Address - Country:US
Practice Address - Phone:480-278-7742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRNP291030363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health