RYAN D ELLEDGE (NPI# 1356892665) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356892665 |
| Entity Type | Individual |
| Full Name | RYAN D ELLEDGE |
| Credential | PA-C |
| Practice Address |
1500 Line Ave Suite 200 Shreveport LA 71101-4639 |
| Practice Telephone | 3186295560 |
| Mailing Telephone | 3186295560 |
| Enumeration Date | 2016-10-21 |
| Last Update Date | 2016-10-21 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
303583 | LA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1500 LINE AVE SUITE 200 |
| City | SHREVEPORT |
| State | LA |
| Zip Code | 71101-4639 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164427829 | Stephen L. Cox | Orthopaedic Surgery | 1500 Line Ave, Suite 100, Shreveport, LA 71101-4644 | 2005-06-17 |
| 1952944894 | Red River Medicine, LLC | Internal Medicine | 1500 Line Ave, Shreveport, LA 71101-4639 | 2019-10-23 |
| 1659871887 | Valerie Taylor Thompson | Physical Therapist | 1500 Line Ave, Shreveport, LA 71101-4639 | 2018-02-14 |
| 1487109138 | Kristen Jones Brezina | Physician Assistant | 1500 Line Ave, Suite 100, Shreveport, LA 71101-4639 | 2016-08-23 |
| 1619328838 | Meghan Marie Williams | Occupational Therapist | 1500 Line Ave, Suite 100, Shreveport, LA 71101-4639 | 2016-06-29 |
| 1285023010 | Mca Specialists Hospital, LLC | Anesthesiology | 1500 Line Ave, Shreveport, LA 71101-4639 | 2015-01-16 |
| 1093131765 | Kelly Daniels | Physical Therapist | 1500 Line Ave, Shreveport, LA 71101-4639 | 2014-03-05 |
| 1245678432 | Laura Elise Bares | Physical Therapist | 1500 Line Ave, Suite 104, Shreveport, LA 71101-4639 | 2013-06-10 |
| 1710233721 | Elvira Cehajic | Nurse Practitioner | 1500 Line Ave, Ste 100, Shreveport, LA 71101-4639 | 2012-07-27 |
| 1437425162 | Stephanie G Candler | Specialist/Technologist, Other | 1500 Line Ave, Suite 200, Shreveport, LA 71101-4639 | 2012-03-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255988630 | Renee Jewitt | Case Manager/Care Coordinator | 1513 Line Avenue, Suite 225, Shreveport, LA 71101 | 2019-08-21 |
| 1942770094 | Bessie Larry | Case Manager/Care Coordinator | 1513 Line Av, 222, Shreveport, LA 71101 | 2018-12-03 |
| 1750875944 | Jarvis Decarleonne Larry | Community Health Worker | 1513 Line Ave # 222, Shreveport, LA 71101 | 2018-06-20 |
| 1871083485 | Kimberly B. Mcclelland, Lcsw | Counselor | 820 Jordan St. Ste 510w, Shreveport, LA 71101 | 2018-05-18 |
| 1982106456 | Hudson Amc LLC | Internal Medicine | 1800 Irving Place, Shreveport, LA 71101 | 2018-03-01 |
| 1528572955 | Spencer Ron Floyd | Counselor | 1717 Marshall Street, Shreveport, LA 71101 | 2017-11-21 |
| 1578088076 | Brittany Morris | Case Manager/Care Coordinator | 1835 Spring Street Annex Building, Shreveport, LA 71101 | 2017-08-07 |
| 1275058794 | Diane Williams | Case Manager/Care Coordinator | 217 Jones St Apt 510, Shreveport, LA 71101 | 2017-08-04 |
| 1386195972 | Jakeya Woodbury | Counselor | 453 Stoner Ave, Shreveport, LA 71101 | 2016-10-18 |
| 1922459643 | Arlene Huling | Counselor | 449 Egan Street, Shreveport, LA 71101 | 2016-06-23 |
| Find all providers in zip 71101 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285290098 | Nicole Michelle Toups | Physician Assistant | 2551 Greenwood Rd Ste 311, Shreveport, LA 71103-3981 | 2019-05-16 |
| 1235220708 | Maribeth Forrest | Physician Assistant | 2800 Hearne Ave, Shreveport, LA 71103-3934 | 2006-09-27 |
| 1821096686 | Charles Girard Tisdale | Physician Assistant | 1455 E Bert Koun Loop, #210, Shreveport, LA 71105-5634 | 2005-07-14 |
| 1609474428 | Thea Christine Fontenot | Physician Assistant | 2751 Albert L Bicknell Dr Ste 5c, Shreveport, LA 71103-3943 | 2020-10-14 |
| 1285145706 | Georgia Shively Monk | Physician Assistant | 7925 Youree Dr, Shreveport, LA 71105-5127 | 2017-10-24 |
| 1194243899 | Serena Shah Frye | Physician Assistant | 2751 Albert L Bicknell Dr Ste 5c, Shreveport, LA 71103-3943 | 2017-09-01 |
| 1104374099 | Britney Brown | Physician Assistant | 2751 Albert L Bicknell Dr, Suite 5c, Shreveport, LA 71103-3920 | 2016-09-20 |
| 1740665694 | Jennifer Michelle Bigbee | Physician Assistant | 2751 Albert L Bicknell Dr, Shreveport, LA 71103-3920 | 2015-07-21 |
| 1356722466 | Surgassist of Shreveport, LLC | Physician Assistant | 949 Olive St, Shreveport, LA 71104-2103 | 2015-06-15 |
| 1225433865 | Courtney Moseley | Physician Assistant | 2751 Albert L Bicknell Dr, Suite 3d, Shreveport, LA 71103-3920 | 2014-10-24 |
| Find all providers in SHREVEPORT | ||||
| City | SHREVEPORT |
| Zip Code | 71101 |
Please comment or provide details below to improve the information on RYAN D ELLEDGE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.