Healthcare Provider Details

I. General information

NPI: 1013634419
Provider Name (Legal Business Name): RYAN ANDREW STACK AGACNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2022
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MEMORIAL HOSPITAL DR STE 200
MOBILE AL
36608-1787
US

IV. Provider business mailing address

101 MEMORIAL HOSPITAL DR STE 200
MOBILE AL
36608-1787
US

V. Phone/Fax

Practice location:
  • Phone: 251-414-5900
  • Fax: 251-459-8964
Mailing address:
  • Phone: 251-414-5900
  • Fax: 251-459-8964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1-181242
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: