Provider Demographics
NPI:1174588560
Name:FAULKNER, RYAN P (PSYD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:P
Last Name:FAULKNER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 S FORT THOMAS AVE
Mailing Address - Street 2:RM 225
Mailing Address - City:FORT THOMAS
Mailing Address - State:KY
Mailing Address - Zip Code:41075-2305
Mailing Address - Country:US
Mailing Address - Phone:513-861-3100
Mailing Address - Fax:859-572-6748
Practice Address - Street 1:1000 S FORT THOMAS AVE
Practice Address - Street 2:RM 225
Practice Address - City:FORT THOMAS
Practice Address - State:KY
Practice Address - Zip Code:41075-2305
Practice Address - Country:US
Practice Address - Phone:513-861-3100
Practice Address - Fax:859-572-6748
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1397103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0927402Medicare PIN