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General NPI Number Information
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NPI Number | 1417438391
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Entity Type | Individual
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Provider Name | JONATHAN TODD RYSER-OATMAN PH.D.
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Gender | Male
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Dates
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Enumeration Date | 08/28/2018
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Last Update Date | 03/13/2023
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Provider Practice Location Address
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Address Line | 989 GOVERNORS LN STE 140
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City | LEXINGTON
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State | KY
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Zip | 40513-1174
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Country | US
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Telephone | 859-494-9984
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Fax |
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Provider Business Mailing Address
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Address Line | 217 STONE AVE APT B
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City | LEXINGTON
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State | KY
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Zip | 40508-2671
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Country | US
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Telephone | 669-300-9412
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 278568
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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