Healthcare Provider Details

I. General information

NPI: 1639083405
Provider Name (Legal Business Name): RYAN WOLF PARAMEDIC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 INDIAN MOUND DR
MT STERLING KY
40353-1151
US

IV. Provider business mailing address

358 4TH ST
RICHMOND KY
40475-1428
US

V. Phone/Fax

Practice location:
  • Phone: 859-497-0120
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number1119709
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: