Individual
RYAN ATWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
207 E 12TH ST, EMMETT, ID 83617-3626
(208) 365-1065
(208) 365-1068
Mailing address
1441 NE 10TH AVE, PAYETTE, ID 83661-5420
(208) 642-9376
(208) 642-9376
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA1824
ID
363A00000X
Physician Assistant
PA207
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500810620
—
OR
Enumeration date
12/12/2019
Last updated
01/13/2026
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