Healthcare Provider Details

I. General information

NPI: 1669064689
Provider Name (Legal Business Name): FRANKIE RYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2021
Last Update Date: 02/10/2021
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2436 PHILLIPS RIDGE RD
FRENCH CREEK WV
26218-2235
US

IV. Provider business mailing address

PO BOX 182
ADRIAN WV
26210-0182
US

V. Phone/Fax

Practice location:
  • Phone: 304-613-8151
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: