Healthcare Provider Details

I. General information

NPI: 1801152079
Provider Name (Legal Business Name): RYAN F MCKENNA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2012
Last Update Date: 12/13/2023
Certification Date: 12/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 MEDI PARK DR STE 2
AMARILLO TX
79106-2105
US

IV. Provider business mailing address

101 W LOUIS HENNA BLVD STE 300
AUSTIN TX
78728-1203
US

V. Phone/Fax

Practice location:
  • Phone: 806-350-7918
  • Fax: 806-418-8982
Mailing address:
  • Phone: 512-244-4272
  • Fax: 512-244-2895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberR1825
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberR1825
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: