Individual
JULIE J RYDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
409 PINE ST, SUITE 200, KLAMATH FALLS, OR 97601-6020
(541) 273-0515
(541) 727-0482
Mailing address
PO BOX 1359, KLAMATH FALLS, OR 97601-0075
(541) 882-1540
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
200750026NPPMHNPPP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
218345
—
OR
01
—
P01093314
RR MEDICARE
OR
01
—
R165122
MEDICARE PTAN
OR
Enumeration date
08/08/2006
Last updated
06/11/2013
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