Healthcare Provider Details

I. General information

NPI: 1255084216
Provider Name (Legal Business Name): CRYSTAL ANNE RYAN DNP, AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2022
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH ST # BB4500
AUGUSTA GA
30912-0004
US

IV. Provider business mailing address

125 SMOKE RIDGE DR
NORTH AUGUSTA SC
29860-9620
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-3153
  • Fax:
Mailing address:
  • Phone: 706-840-0921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN276538
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: