MEDICARE: MANDI NICOLE RYAN BCBA

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	103K00000X	Behavior Analyst	1-23-64591	MS
2	103K00000X	Behavior Analyst	220054	MS

General Provider Information

NPI Number	:	1619672276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANDI NICOLE RYAN BCBA

Provider Business Mailing Address
First Line	:	124 COX ST
Second Line	:
City	:	BALDWYN
State	:	MS
Zip	:	38824-1509
Country	:	US
Telephone Number	:	662-213-4191
Fax Number	:

Provider Business Practice Location Address
First Line	:	1040 CLIFF GOOKIN BLVD STE H
Second Line	:
City	:	TUPELO
State	:	MS
Zip	:	38801-6467
Country	:	US
Telephone Number	:	662-205-4375
Fax Number	:

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

Provider Enumeration Date	:	04/03/2023
Last Update Date	:	04/03/2023

Similar Medicare Providers

1104771005 — MORELIFE HEALTH INNOVATIONS
Practice Location Address:

1040 CLIFF GOOKIN BLVD STE I
TUPELO, MS
38801-6467

Practice Phone: 615-944-9526
Practice Fax:

1164127726 — MRS. MORGAN KENT M.S., BCBA, LBA
Practice Location Address:

1040 CLIFF GOOKIN BLVD STE H
TUPELO, MS
38801-6467

Practice Phone: 662-205-4375
Practice Fax: 662-584-2990

1154285211 — CORNERSTONE CAREGIVING EAST LLC
Practice Location Address:

1040 CLIFF GOOKIN BLVD STE H
TUPELO, MS
38801-6467

Practice Phone: 662-584-4407
Practice Fax:

1952767634 — JENNIFER ROBERTS LMSW
Practice Location Address:

520 S GLOSTER ST
TUPELO, MS
38801-5528

Practice Phone: 662-350-3914
Practice Fax:

1295711281 — NORTH MISSISSIPPI MEDCIAL CENTER, INC.
Practice Location Address:

738 S GLOSTER ST STE A
TUPELO, MS
38801-4932

Practice Phone: 662-377-4359
Practice Fax: 662-377-3685

1972509099 — GILBERT'S HOME HEALTH AGENCY, INC.
Practice Location Address:

3402 W MAIN ST
TUPELO, MS
38801-9412

Practice Phone: 662-844-9725
Practice Fax:

Directions to “ MANDI NICOLE RYAN BCBA” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.