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Individual

RYAN J NETTLES

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
3651 COLLEGE BLVD, #100A, LEAWOOD, KS 66211-1904
(913) 319-7546
(913) 319-7691
Mailing address
3651 COLLEGE BLVD, #100A, LEAWOOD, KS 66211-1904
(913) 319-7546
(913) 319-7691

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
05-25395
KS
363A00000X
Physician Assistant
2004027792
MO
363A00000X
Physician Assistant
Primary
PA-2940
CO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
61037729
CO
Enumeration date
07/13/2005
Last updated
06/06/2011
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