Provider Demographics
NPI:1093699324
Name:VANCE, RYAN ALEXANDER
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:ALEXANDER
Last Name:VANCE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3906 SW MOLINE AVE
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-7505
Mailing Address - Country:US
Mailing Address - Phone:417-399-0053
Mailing Address - Fax:
Practice Address - Street 1:200 CARR ST
Practice Address - Street 2:
Practice Address - City:PEA RIDGE
Practice Address - State:AR
Practice Address - Zip Code:72751-2782
Practice Address - Country:US
Practice Address - Phone:479-488-6415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-31
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR232429163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse