Provider Demographics
NPI:1831493196
Name:RYAN, JAMES LEE
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:LEE
Last Name:RYAN
Suffix:
Gender:
Credentials:
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 790
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-0790
Mailing Address - Country:US
Mailing Address - Phone:606-329-8588
Mailing Address - Fax:606-796-6221
Practice Address - Street 1:3701 LANDSDOWNE DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41102-5422
Practice Address - Country:US
Practice Address - Phone:066-329-8588
Practice Address - Fax:606-329-8140
Is Sole Proprietor?:No
Enumeration Date:2010-12-30
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6463P363LF0000X
KY3006463363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3124096Medicaid
KY7100149730Medicaid
P400037218Medicare PIN