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1912729831 NPI number — KELLEN RYAN PA

NPI Number: 1912729831
Health Care Provider/Practitioner: KELLEN RYAN PA

Information about “1912729831” NPI (KELLEN RYAN PA) exists in 1912729831 in HTML format HTML  |  1912729831 in plain Text format TXT  |  1912729831 in PDF (Portable Document Format) PDF  |  1912729831 in an XML format XML  formats.

NPI Number : 1912729831 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1912729831",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "RYAN",
    "FirstName": "KELLEN",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3A LACE LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CLIFTON PARK",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "12065-3605",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "211 CHURCH ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SARATOGA SPRINGS",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "12866-1090",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "518-587-3222",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/30/2024",
    "LastUpdateDate": "11/11/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "363AM0700X",
          "TaxonomyName": "Medical Physician Assistant",
          "LicenseNumber": "032029",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363AS0400X",
          "TaxonomyName": "Surgical Physician Assistant",
          "LicenseNumber": "032029",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": "032029",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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