MEDICARE: KIM A RYAN PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	898	OK

General Provider Information

NPI Number	:	1396927760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM A RYAN PA

Provider Business Mailing Address
First Line	:	PO BOX 269064
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73126-9064
Country	:	US
Telephone Number	:	405-231-3857
Fax Number	:	405-272-7977

Provider Business Practice Location Address
First Line	:	6908 E RENO AVE
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73110-2128
Country	:	US
Telephone Number	:	405-737-7000
Fax Number	:	405-737-7700

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2007
Last Update Date	:	10/18/2020

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Directions to “ KIM A RYAN PA” Practice Location

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