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NPI Code Detail

MEDICARE: RYAN ANDREW NUSSBAUM PA-C

MEDICARE: RYAN ANDREW NUSSBAUM PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant2739OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1093259509
Entity Type Code : Individual
Provider Name (Legal Business Name) : RYAN ANDREW NUSSBAUM PA-C
Provider Business Mailing Address
First Line : 2488 E 81ST ST STE 290
Second Line :
City : TULSA
State : OK
Zip : 74137-4299
Country : US
Telephone Number : 918-494-2665
Fax Number : 918-927-3201
Provider Business Practice Location Address
First Line : 2488 E 81ST ST STE 290
Second Line :
City : TULSA
State : OK
Zip : 74137-4265
Country : US
Telephone Number : 918-494-2665
Fax Number : 918-927-3193
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/19/2016
Last Update Date : 12/01/2025

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Directions to “ RYAN ANDREW NUSSBAUM PA-C” Practice Location

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