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General NPI Number Information
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NPI Number | 1144962192
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Entity Type | Individual
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Provider Name | RYAN JAMES CONDON FNP-BC
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Gender | Male
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Dates
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Enumeration Date | 04/11/2022
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 801 W FM 117
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City | DILLEY
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State | TX
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Zip | 78017-3409
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Country | US
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Telephone | 830-326-3171
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Fax |
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Provider Business Mailing Address
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Address Line | 750 INWOOD
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City | POTEET
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State | TX
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Zip | 78065-3936
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Country | US
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Telephone | 630-461-8808
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1074006
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License Number State | TX
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