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General NPI Number Information
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NPI Number | 1467035550
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Entity Type | Individual
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Provider Name | RYAN BEATTY
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Gender | Male
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Dates
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Enumeration Date | 05/05/2021
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Last Update Date | 05/05/2021
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Provider Practice Location Address
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Address Line | 610 E BASELINE RD
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City | TEMPE
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State | AZ
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Zip | 85283-1204
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Country | US
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Telephone | 602-527-0791
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Fax |
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Provider Business Mailing Address
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Address Line | 304 S JONES BLVD # 2022
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City | LAS VEGAS
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State | NV
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Zip | 89107-2623
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Country | US
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Telephone | 310-877-0127
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP7489
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License Number State | AZ
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