=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770303026
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RYLAN WILLKENS DNP, AGACNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/11/2024
-----------------------------------------------------
Last Update Date | 12/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17189 INTERSTATE 45 S STE 475
-----------------------------------------------------
City | SHENANDOAH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77385-3320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-270-3933
-----------------------------------------------------
Fax | 713-791-5134
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21326 SIERRA POINT LN
-----------------------------------------------------
City | PORTER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77365-7288
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-459-9616
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | 1175665
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------