Provider Demographics
NPI:1013240134
Name:RYAN, MARTHA LYN (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:LYN
Last Name:RYAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 S 8TH ST
Mailing Address - Street 2:SUITE 480 WEST
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-2400
Mailing Address - Country:US
Mailing Address - Phone:270-762-1515
Mailing Address - Fax:270-752-2852
Practice Address - Street 1:300 S 8TH ST
Practice Address - Street 2:SUITE 480 WEST
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-2400
Practice Address - Country:US
Practice Address - Phone:270-753-0704
Practice Address - Fax:270-752-2852
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY3006171363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100099930Medicaid
KY7100099930Medicaid
KY000000665848OtherANTHEM