MEDICARE: LYDIA RYAN PMHNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1136265	AL

General Provider Information

NPI Number	:	1962352351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYDIA RYAN PMHNP

Provider Business Mailing Address
First Line	:	3644 RAINBOW DR
Second Line	:
City	:	RAINBOW CITY
State	:	AL
Zip	:	35906-6313
Country	:	US
Telephone Number	:	256-613-2678
Fax Number	:	256-438-5341

Provider Business Practice Location Address
First Line	:	133 N CHALKVILLE RD
Second Line	:
City	:	TRUSSVILLE
State	:	AL
Zip	:	35173-1376
Country	:	US
Telephone Number	:	205-588-6527
Fax Number	:	205-508-3114

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

Provider Enumeration Date	:	02/03/2026
Last Update Date	:	04/13/2026

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