Healthcare Provider Details

I. General information

NPI: 1548963861
Provider Name (Legal Business Name): KELLY RYAN APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2023
Last Update Date: 03/27/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 S. STATE STREET BAYHEALTH WOUND CARE CENTER, 2ND FLOOR
DOVER DE
19901
US

IV. Provider business mailing address

640 S. STATE ST. MAIL CODE 3055
DOVER DE
19901-3530
US

V. Phone/Fax

Practice location:
  • Phone: 302-744-7500
  • Fax:
Mailing address:
  • Phone: 302-480-1688
  • Fax: 302-480-9807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0012296
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberLG-0012296
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: