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General NPI Number Information
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NPI Number | 1336730084
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Entity Type | Individual
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Provider Name | TODD RYAN BOMAR PMHNP-BC
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Gender | Male
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Dates
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Enumeration Date | 01/26/2021
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Last Update Date | 04/20/2026
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Provider Practice Location Address
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Address Line | 1570 WAVERLY RD
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City | KINGSPORT
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State | TN
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Zip | 37664-2523
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Country | US
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Telephone | 423-224-1300
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Fax | 423-467-3644
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Provider Business Mailing Address
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Address Line | 3022 VANDERBILT PL
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City | NASHVILLE
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State | TN
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Zip | 37212-2500
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Country | US
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Telephone | 615-393-3792
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Fax | 615-334-0896
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 29138
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 11011297
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 0024182774
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 236371
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License Number State | AR
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