Provider Demographics
NPI:1477371128
Name:RYAN, TARA JANE (DNP, APRN, FNP-BC)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:JANE
Last Name:RYAN
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 S PARK RANCH RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83001-9438
Mailing Address - Country:US
Mailing Address - Phone:307-413-5698
Mailing Address - Fax:
Practice Address - Street 1:2055 S PARK RANCH RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001-9438
Practice Address - Country:US
Practice Address - Phone:307-413-5698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-01
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY47218363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily