Individual
MRS. BONNIE BASS RYAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2106 NORTH RAGUET STREET, NACOGDOCHES, TX 75962-4437
(936) 468-4008
(936) 468-1316
Mailing address
PO BOX 512, ETOILE, TX 75944-0512
(936) 465-5436
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA 03470
TX
363A00000X
Physician Assistant
PA03470
TX
363AM0700X
Medical Physician Assistant
PA03470
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA03470
STATE PA LICENSE NUMBER
TX
Enumeration date
06/26/2006
Last updated
02/18/2020
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