Provider Demographics
NPI:1720127020
Name:DUARTE, RYAN PAUL (MA, PA-C)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:PAUL
Last Name:DUARTE
Suffix:
Gender:M
Credentials:MA, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7425 WRIGLEY DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-5292
Mailing Address - Country:US
Mailing Address - Phone:509-545-6220
Mailing Address - Fax:
Practice Address - Street 1:7425 WRIGLEY DR
Practice Address - Street 2:SUITE 100
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-5292
Practice Address - Country:US
Practice Address - Phone:509-545-6220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60136962101YM0800X
WAPA60604338363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health