Healthcare Provider Details

I. General information

NPI: 1093043820
Provider Name (Legal Business Name): ANDREA LEIGH RYAN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2009
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 GALLIA ST
PORTSMOUTH OH
45662-4232
US

IV. Provider business mailing address

411 COURT ST
PORTSMOUTH OH
45662-3932
US

V. Phone/Fax

Practice location:
  • Phone: 740-354-0700
  • Fax: 740-876-8691
Mailing address:
  • Phone: 740-354-0700
  • Fax: 740-876-8691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number6276P
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11337
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.11337
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: