Healthcare Provider Details

I. General information

NPI: 1629648431
Provider Name (Legal Business Name): RYANN KAYLEIGH NOLAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2021
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

570 READ SCHOOL HOUSE RD
COVENTRY RI
02816-8706
US

IV. Provider business mailing address

10 LONGMEADOW RD
HINGHAM MA
02043-3421
US

V. Phone/Fax

Practice location:
  • Phone: 401-557-6909
  • Fax:
Mailing address:
  • Phone: 781-801-3593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberCPA01938
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA8214
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: