Provider Demographics
NPI:1720022767
Name:MOBLEY, RYAN M (NP)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:M
Last Name:MOBLEY
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 6423
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85246-6423
Mailing Address - Country:US
Mailing Address - Phone:480-245-6286
Mailing Address - Fax:
Practice Address - Street 1:11209 N TATUM BLVD STE 260
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-6025
Practice Address - Country:US
Practice Address - Phone:602-494-6800
Practice Address - Fax:602-494-6803
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP1873363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ836984Medicaid
AZ836984Medicaid
AZ836984Medicaid
Z129470Medicare PIN