Provider Demographics
NPI:1851066542
Name:MYERS, PAIGE RYANN
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:RYANN
Last Name:MYERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 E SUMMIT ST STE 3
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-3477
Mailing Address - Country:US
Mailing Address - Phone:219-240-1582
Mailing Address - Fax:
Practice Address - Street 1:503 E SUMMIT ST STE 3
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-3477
Practice Address - Country:US
Practice Address - Phone:219-240-1582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-13
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK205033207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK205033Medicaid