Provider Demographics
NPI:1356591713
Name:RYLE, STEPHANIE R (NP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:R
Last Name:RYLE
Suffix:
Gender:F
Credentials:NP
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 846098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6098
Mailing Address - Country:US
Mailing Address - Phone:903-324-6400
Mailing Address - Fax:
Practice Address - Street 1:2026 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:TX
Practice Address - Zip Code:75766-5822
Practice Address - Country:US
Practice Address - Phone:903-586-5678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN231598363LF0000X
TXAP118789363LF0000X
TX778564363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX75-2616977-008OtherTRICARE
TXTPI 2137671-01Medicaid
TX75-2616977-015OtherTRICARE
TX8366NXOtherBCBS
TX213767102Medicaid
TX213767103Medicaid
TX75-2616977-083OtherTRICARE
TXP01806544OtherRAIL ROAD MEDICARE
TX75-2616977-008OtherTRICARE
TX75-2616977-083OtherTRICARE
GA20250I3855Medicare PIN
IL0533210001Medicare NSC