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General NPI Number Information
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NPI Number | 1255870184
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Entity Type | Organization
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Legal Business Name | RYAN PEDIATRICS
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Dates
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Enumeration Date | 02/12/2017
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Last Update Date | 02/12/2017
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Provider Practice Location Address
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Address Line | 2000 10TH ST
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City | FLORESVILLE
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State | TX
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Zip | 78114-2770
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Country | US
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Telephone | 830-393-7256
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Fax |
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Provider Business Mailing Address
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Address Line | 5450 FM 536
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City | FLORESVILLE
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State | TX
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Zip | 78114-4970
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Country | US
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Telephone | 830-393-7256
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. ALYSON MARIE RYAN
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Credential | MSN, RN, CPNP-PC
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Telephone | 830-393-7256
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | H3300
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | AP126571
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License Number State | TX
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