Healthcare Provider Details

I. General information

NPI: 1992227789
Provider Name (Legal Business Name): RYAN SCOTT CARLSON NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2017
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 W 3RD ST
DORRIS CA
96023-9100
US

IV. Provider business mailing address

610 W 3RD ST
DORRIS CA
96023-9100
US

V. Phone/Fax

Practice location:
  • Phone: 530-999-9070
  • Fax:
Mailing address:
  • Phone: 530-999-9070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704282755
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95012004
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: