Individual
JENISA K RYALS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1108 ROSS CLARK CIR, DOTHAN, AL 36301-3022
(334) 255-7747
(877) 374-1670
Mailing address
PO BOX 311311, ENTERPRISE, AL 36331-1311
(334) 255-7747
(877) 374-1670
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA 166
AL
363A00000X
Physician Assistant
PA9101955
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
059054065
BCBS OF ALABAMA
AL
05
—
291215500
—
FL
05
—
891003240
—
AL
Enumeration date
10/04/2006
Last updated
08/02/2024
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