Provider Demographics
NPI:1649588062
Name:RYE, VANESSA MARIE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:MARIE
Last Name:RYE
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3031 W IH 10
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-5159
Mailing Address - Country:US
Mailing Address - Phone:210-261-1000
Mailing Address - Fax:210-731-9678
Practice Address - Street 1:3031 W IH 10
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78201-5159
Practice Address - Country:US
Practice Address - Phone:210-261-1000
Practice Address - Fax:210-731-9678
Is Sole Proprietor?:No
Enumeration Date:2010-09-20
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX551746363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX304932201Medicaid
TXTXB158822Medicare PIN