Provider Demographics
NPI:1245372622
Name:RYAN, KATHLEEN (APN)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6907 ELLIS CT APT C
Mailing Address - Street 2:6907 C
Mailing Address - City:FORT POLK
Mailing Address - State:LA
Mailing Address - Zip Code:71459-3123
Mailing Address - Country:US
Mailing Address - Phone:337-281-1040
Mailing Address - Fax:
Practice Address - Street 1:6907 ELLIS CT APT C
Practice Address - Street 2:6907 C
Practice Address - City:FORT POLK
Practice Address - State:LA
Practice Address - Zip Code:71459-3123
Practice Address - Country:US
Practice Address - Phone:337-281-1040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX254355363LA2200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily