Provider Demographics
NPI:1508584681
Name:WALDEN, RYAN THOMAS (PA)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:THOMAS
Last Name:WALDEN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:941 W I 35 FRONTAGE RD STE 164
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-7375
Mailing Address - Country:US
Mailing Address - Phone:405-285-2994
Mailing Address - Fax:
Practice Address - Street 1:941 W I 35 FRONTAGE RD STE 164
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-7375
Practice Address - Country:US
Practice Address - Phone:405-285-2994
Practice Address - Fax:405-285-2997
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2025-06-24
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant