MEDICARE: RYAN SEVER PSY.D

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
1	103T00000X	Psychologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1530488140	OTHER		MILITARY

General Provider Information

NPI Number	:	1114568268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN SEVER PSY.D

Provider Business Mailing Address
First Line	:	300 W HOSPITAL RD
Second Line	:
City	:	FORT GORDON
State	:	GA
Zip	:	30905-5741
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4539 N 5TH ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-2548
Country	:	US
Telephone Number	:	702-816-6022
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2019
Last Update Date	:	08/26/2022

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Directions to “ RYAN SEVER PSY.D” Practice Location

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