Healthcare Provider Details

I. General information

NPI: 1104783778
Provider Name (Legal Business Name): MRS. RYAN YVETTE BLETCHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1891 HONEYSUCKLE RD STE 2
DOTHAN AL
36305-4291
US

IV. Provider business mailing address

1891 HONEYSUCKLE RD STE 2
DOTHAN AL
36305-4291
US

V. Phone/Fax

Practice location:
  • Phone: 334-386-0860
  • Fax: 334-678-7225
Mailing address:
  • Phone: 334-386-0860
  • Fax: 334-678-7225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1-145216
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: