Provider Demographics
NPI:1063777324
Name:GILCHRIST, RYAN ISAAC (RN)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:ISAAC
Last Name:GILCHRIST
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2914 INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77803-1070
Mailing Address - Country:US
Mailing Address - Phone:979-778-2031
Mailing Address - Fax:
Practice Address - Street 1:2914 INDIANA AVE
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77803-1070
Practice Address - Country:US
Practice Address - Phone:979-778-2031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6750783747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant