Provider Demographics
NPI:1144315961
Name:RYALS, DANNY R JR (FNP)
Entity type:Individual
Prefix:
First Name:DANNY
Middle Name:R
Last Name:RYALS
Suffix:JR
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:318-966-6800
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:3100 FORSYTHE AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3014
Practice Address - Country:US
Practice Address - Phone:318-966-6800
Practice Address - Fax:318-966-6801
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04317363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1172375Medicaid
LA363404YJBUMedicare PIN
LA4C828Medicare ID - Type Unspecified