Provider Demographics
NPI:1144219064
Name:RYAN, KRISTEN (MD)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7023 OLD JAHNKE RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4126
Mailing Address - Country:US
Mailing Address - Phone:804-320-1353
Mailing Address - Fax:804-320-6636
Practice Address - Street 1:7023 OLD JAHNKE RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-4126
Practice Address - Country:US
Practice Address - Phone:804-320-1353
Practice Address - Fax:804-320-6636
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101227717174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7717146OtherAETNA/US HEALTHCARE ID
VA217191OtherANTHEM ID
VA1201873OtherUNITED HEALTHCARE ID
VA287117OtherMAMSI ID
VA011353OtherCIGNA ID
VA1896314OtherFIRST HEALTH ID
VA127722OtherSOUTHERN HEALTH ID
VA006720218Medicaid