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NPI Code Detail

MEDICARE: JACK RYAN MARTIN RN

MEDICARE: JACK RYAN MARTIN RN
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
1163WE0003XEmergency Registered Nurse220260AR

General Provider Information

NPI Number : 1700731064
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACK RYAN MARTIN RN
Provider Business Mailing Address
First Line : 3972 N PARKSIDE DR APT 3
Second Line :
City : FAYETTEVILLE
State : AR
Zip : 72703-7089
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3215 N NORTHHILLS BLVD
Second Line :
City : FAYETTEVILLE
State : AR
Zip : 72703-4424
Country : US
Telephone Number : 479-463-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/02/2026
Last Update Date : 03/02/2026

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Directions to “ JACK RYAN MARTIN RN” Practice Location

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