Provider Demographics
NPI:1972990281
Name:RICHARDS, RYAN DAVID (PA-C)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:DAVID
Last Name:RICHARDS
Suffix:
Gender:M
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 1:3627 ENSIGN RD NE STE A
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-6104
Mailing Address - Country:US
Mailing Address - Phone:360-998-3232
Mailing Address - Fax:360-298-7138
Practice Address - Street 1:3627 ENSIGN RD NE STE A
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-6104
Practice Address - Country:US
Practice Address - Phone:360-998-3232
Practice Address - Fax:360-298-7138
Is Sole Proprietor?:No
Enumeration Date:2015-04-24
Last Update Date:2020-04-22
Deactivation Date:2020-03-04
Deactivation Code:
Reactivation Date:2020-04-21
Provider Licenses
StateLicense IDTaxonomies
MAPA5227363A00000X
WAPA60945559363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant