Healthcare Provider Details

I. General information

NPI: 1427839349
Provider Name (Legal Business Name): RYAM NEUPANE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2023
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11206 JEFFERSON TRACE BLVD
LOUISVILLE KY
40291-3695
US

IV. Provider business mailing address

11206 JEFFERSON TRACE BLVD
LOUISVILLE KY
40291-3695
US

V. Phone/Fax

Practice location:
  • Phone: 502-836-9931
  • Fax:
Mailing address:
  • Phone: 502-836-9931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: