Provider Demographics
NPI:1003422502
Name:RYAN, CLAIRE M (PA-C)
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:M
Last Name:RYAN
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:8204 COTTAGE ROSE DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78744-5924
Mailing Address - Country:US
Mailing Address - Phone:630-470-8094
Mailing Address - Fax:
Practice Address - Street 1:3707 S 2ND ST STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7049
Practice Address - Country:US
Practice Address - Phone:512-324-9170
Practice Address - Fax:512-441-6388
Is Sole Proprietor?:No
Enumeration Date:2020-09-20
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
363A00000X
TXPA15579363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant