MEDICARE: KRISTEN NICOLE RYAN

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	L8-0010439	DE

General Provider Information

NPI Number	:	1740965292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN NICOLE RYAN

Provider Business Mailing Address
First Line	:	5205 W WOODMILL DR STE 33LL1Q
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19808-4068
Country	:	US
Telephone Number	:	631-317-8543
Fax Number	:	302-406-2741

Provider Business Practice Location Address
First Line	:	5205 W WOODMILL DR STE 33LL
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19808-4068
Country	:	US
Telephone Number	:	302-268-3020
Fax Number	:	302-406-2741

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

Provider Enumeration Date	:	06/21/2023
Last Update Date	:	06/17/2026

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Directions to “ KRISTEN NICOLE RYAN ” Practice Location

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