Basic Information
| Provider Information | |||||||||
| NPI: | 1376555664 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEACHY | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 107 E MOUNTAIN VIEW AVE | ||||||||
| Address2: | |||||||||
| City: | ELLENSBURG | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989265312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5099626348 | ||||||||
| FaxNumber: | 5099622003 | ||||||||
| Practice Location | |||||||||
| Address1: | 3909 CREEKSIDE LOOP STE 115 | ||||||||
| Address2: | |||||||||
| City: | YAKIMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989024880 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5095746095 | ||||||||
| FaxNumber: | 5095746098 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2006 | ||||||||
| LastUpdateDate: | 06/22/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA10005054 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.