Individual
MR. RYAN EARL FARMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
130 W RAVINE RD, KINGSPORT, TN 37660-3837
(423) 224-4000
Mailing address
200 CORPORATE BLVD, LAFAYETTE, LA 70508-3870
(800) 893-9698
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
0110-007376
VA
363A00000X
Physician Assistant
Primary
4231
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0110-007376
STATE LICENSING BOARD
VA
Enumeration date
07/29/2020
Last updated
07/19/2021
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