Provider Demographics
NPI:1780242032
Name:LAHEY, RYAN T (PA-C)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:T
Last Name:LAHEY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 AYLWARD AVE
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:67439-2541
Mailing Address - Country:US
Mailing Address - Phone:785-472-5029
Mailing Address - Fax:785-472-5731
Practice Address - Street 1:1602 AYLWARD AVE
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:KS
Practice Address - Zip Code:67439-2541
Practice Address - Country:US
Practice Address - Phone:785-472-5029
Practice Address - Fax:785-472-5731
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-02
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS50869146N00000X
2255A2300X
KS1502245363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer