Provider Demographics
NPI:1396927760
Name:RYAN, KIM A (PA)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:A
Last Name:RYAN
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:PO BOX 269064
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-9064
Mailing Address - Country:US
Mailing Address - Phone:405-231-3857
Mailing Address - Fax:405-272-7977
Practice Address - Street 1:6908 E RENO AVE
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-2128
Practice Address - Country:US
Practice Address - Phone:405-737-7000
Practice Address - Fax:405-737-7700
Is Sole Proprietor?:No
Enumeration Date:2007-11-28
Last Update Date:2020-10-18
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Provider Licenses
StateLicense IDTaxonomies
OK898363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP69366Medicare UPIN