Provider Demographics
NPI:1659109668
Name:NEAREY, RYAN KELLIE
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:KELLIE
Last Name:NEAREY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RYAN
Other - Middle Name:KELLIE
Other - Last Name:SLIFE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:822 LINCOLN AVE # A
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-5322
Mailing Address - Country:US
Mailing Address - Phone:701-426-9472
Mailing Address - Fax:
Practice Address - Street 1:822 LINCOLN AVE # A
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-5322
Practice Address - Country:US
Practice Address - Phone:701-426-9472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health