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General NPI Number Information
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NPI Number | 1285242230
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Entity Type | Individual
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Provider Name | RYAN T HAZELWOOD FNP
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Gender | Male
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Dates
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Enumeration Date | 07/15/2020
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Last Update Date | 11/26/2025
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Provider Practice Location Address
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Address Line | 111 S LAUREL AVE
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City | LULING
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State | TX
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Zip | 78648-2624
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Country | US
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Telephone | 830-875-6399
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Fax | 855-825-2552
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Provider Business Mailing Address
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Address Line | PO BOX 1890
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City | GONZALES
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State | TX
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Zip | 78629-1390
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Country | US
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Telephone | 830-672-6511
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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 | 1003193
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License Number State | TX
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