Healthcare Provider Details

I. General information

NPI: 1285388421
Provider Name (Legal Business Name): RYAN E TERRY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2022
Last Update Date: 10/11/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 E GLENN AVE
AUBURN AL
36830-5998
US

IV. Provider business mailing address

1935 E GLENN AVE
AUBURN AL
36830-5998
US

V. Phone/Fax

Practice location:
  • Phone: 334-647-1811
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1-162997
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number1-162997
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: