Healthcare Provider Details

I. General information

NPI: 1285825208
Provider Name (Legal Business Name): BRANDON RYAN PA-C, NREMT-P
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 GARDNER RD
WILMINGTON NC
28405-8873
US

IV. Provider business mailing address

1705 GARDNER RD
WILMINGTON NC
28405-8873
US

V. Phone/Fax

Practice location:
  • Phone: 910-343-5300
  • Fax:
Mailing address:
  • Phone: 910-343-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberP071746
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License Number6611
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA06145
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0010-01834
License Number StateNC
# 5
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-01834
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: