Healthcare Provider Details

I. General information

NPI: 1508466467
Provider Name (Legal Business Name): RYAIN ALEXANDER NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2020
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 E BANKHEAD ST
NEW ALBANY MS
38652-3910
US

IV. Provider business mailing address

7388 CROSSWINDS BLVD
HERNANDO MS
38632-1184
US

V. Phone/Fax

Practice location:
  • Phone: 662-469-5659
  • Fax: 662-929-0007
Mailing address:
  • Phone: 662-587-4446
  • Fax: 662-929-0007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number28182
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number904267
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: