Provider Demographics
NPI:1164283529
Name:KINGSOLVER, RYAN (PA-C)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:KINGSOLVER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1055 N 500 W
Mailing Address - Street 2:ATTN CREDENTIALING
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3305
Mailing Address - Country:US
Mailing Address - Phone:801-354-8225
Mailing Address - Fax:801-418-0941
Practice Address - Street 1:2230 N UNIVERSITY PKWY STE 9B
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-6717
Practice Address - Country:US
Practice Address - Phone:801-375-3175
Practice Address - Fax:801-375-2818
Is Sole Proprietor?:No
Enumeration Date:2024-01-22
Last Update Date:2024-05-14
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant