Healthcare Provider Details

I. General information

NPI: 1801360623
Provider Name (Legal Business Name): RYAN ANTHONY PRESTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2019
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 BYPASS RD BLDG A
PIKEVILLE KY
41501-1689
US

IV. Provider business mailing address

PO BOX 432
PIKEVILLE KY
41502-0432
US

V. Phone/Fax

Practice location:
  • Phone: 606-430-3500
  • Fax: 606-437-1033
Mailing address:
  • Phone: 606-430-3500
  • Fax: 606-437-1033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3013036
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: