MEDICARE: RYAN MATTHEW BELLOMY AGACNP, FNP

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	363L00000X	Nurse Practitioner	27489	TN

General Provider Information

NPI Number	:	1659998425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN MATTHEW BELLOMY AGACNP, FNP

Provider Business Mailing Address
First Line	:	210 WALMART DR
Second Line	:
City	:	SODDY DAISY
State	:	TN
Zip	:	37379-5022
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 WALMART DR
Second Line	:
City	:	SODDY DAISY
State	:	TN
Zip	:	37379-5022
Country	:	US
Telephone Number	:	423-332-6155
Fax Number	:

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

Provider Enumeration Date	:	06/28/2020
Last Update Date	:	04/09/2026

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