Basic Information
Provider Information
NPI: 1447614730
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FERRELL
FirstName: RYAN
MiddleName: MARSHALL
NamePrefix:  
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8717 W 110TH ST STE 600
Address2:  
City: OVERLAND PARK
State: KS
PostalCode: 662102126
CountryCode: US
TelephoneNumber: 9134282900
FaxNumber: 9134282951
Practice Location
Address1: 5721 W 119TH ST
Address2:  
City: OVERLAND PARK
State: KS
PostalCode: 66209
CountryCode: US
TelephoneNumber: 9134282900
FaxNumber: 9134282951
Other Information
ProviderEnumerationDate: 04/12/2016
LastUpdateDate: 07/17/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000X43-557618KSY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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