Provider Demographics
NPI:1255002788
Name:MCKAY, RYAN THOMAS
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:THOMAS
Last Name:MCKAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 354
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:ND
Mailing Address - Zip Code:58571-0354
Mailing Address - Country:US
Mailing Address - Phone:701-880-0213
Mailing Address - Fax:
Practice Address - Street 1:116 4TH ST NE
Practice Address - Street 2:
Practice Address - City:BEULAH
Practice Address - State:ND
Practice Address - Zip Code:58523-6619
Practice Address - Country:US
Practice Address - Phone:701-880-0213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant