Provider Demographics
NPI:1003629460
Name:RYAN, KEELEY FERRELL (PA-C)
Entity type:Individual
Prefix:MS
First Name:KEELEY
Middle Name:FERRELL
Last Name:RYAN
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:36 COUNTRYSIDE LN
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-3310
Mailing Address - Country:US
Mailing Address - Phone:954-790-4312
Mailing Address - Fax:
Practice Address - Street 1:1201 S GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-1016
Practice Address - Country:US
Practice Address - Phone:314-257-1320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant