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NPI Code Detail

MEDICARE: RYAN CASEY NULPH P.A.-C.

MEDICARE: RYAN CASEY NULPH P.A.-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
1390200000XStudent in an Organized Health Care Education/Training Program
2363A00000XPhysician AssistantPA06696TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1174852693
Entity Type Code : Individual
Provider Name (Legal Business Name) : RYAN CASEY NULPH P.A.-C.
Provider Business Mailing Address
First Line : 12221 MERIT DR STE 1610
Second Line :
City : DALLAS
State : TX
Zip : 75251-2204
Country : US
Telephone Number : 214-217-1911
Fax Number : 214-217-1912
Provider Business Practice Location Address
First Line : 12221 MERIT DR STE 1610
Second Line :
City : DALLAS
State : TX
Zip : 75251-2204
Country : US
Telephone Number : 214-217-1911
Fax Number : 214-217-1912
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/11/2009
Last Update Date : 11/21/2011

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Directions to “ RYAN CASEY NULPH P.A.-C.” Practice Location

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