Individual
JACLYN NICOLE RYAVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1397 S LOOP RD, PAHRUMP, NV 89048-4729
(775) 727-5500
(775) 727-5696
Mailing address
6355 S BUFFALO DR FL 3, LAS VEGAS, NV 89113-2133
(702) 216-3346
(702) 671-6883
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DO2920
NV
207Q00000X
Family Medicine Physician
SL1362
NV
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1518462746
—
NV
01
—
DO2920
STATE LICENSE
NV
01
—
SL1362
MEDICAL LICENSE
NV
Enumeration date
03/28/2018
Last updated
03/07/2023
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