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General NPI Number Information
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NPI Number | 1407548712
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Entity Type | Individual
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Provider Name | TIMMON HAYLEY RYAN PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/24/2023
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Last Update Date | 09/16/2024
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Provider Practice Location Address
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Address Line | 9300 E 29TH ST N STE 206
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City | WICHITA
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State | KS
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Zip | 67226-2183
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Country | US
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Telephone | 316-685-1367
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Fax |
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Provider Business Mailing Address
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Address Line | 551 N HILLSIDE ST STE 320
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City | WICHITA
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State | KS
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Zip | 67214-4926
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Country | US
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Telephone | 316-685-1367
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 15-02803
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License Number State | KS
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