Individual
RYAN ANDREW STACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
AGACNP-BC
Contact information
Practice address
1802 6TH AVE S, BIRMINGHAM, AL 35233-1932
(205) 994-3411
Mailing address
1802 6TH AVE S, BIRMINGHAM, AL 35233-1932
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1-181242
AL
363LA2100X
Acute Care Nurse Practitioner
Primary
1-181242
AL
Other
Enumeration date
10/26/2022
Last updated
10/11/2024
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