Provider Demographics
NPI:1225599533
Name:SMITH, RYAN PHILIP (PA-C)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:PHILIP
Last Name:SMITH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13321 W 104TH ST
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-2115
Mailing Address - Country:US
Mailing Address - Phone:913-267-1943
Mailing Address - Fax:
Practice Address - Street 1:2330 E MEYER BLVD STE 505
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64132-1152
Practice Address - Country:US
Practice Address - Phone:913-267-1943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-28
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019024114363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant