Provider Demographics
NPI:1386455764
Name:DUBLIN, RYAN MICHELLE
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:MICHELLE
Last Name:DUBLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2446 S COUNTY ROAD 1040
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:TX
Mailing Address - Zip Code:79782-9304
Mailing Address - Country:US
Mailing Address - Phone:432-599-8443
Mailing Address - Fax:
Practice Address - Street 1:400 ROSALIND REDFERN GROVER PKWY
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-5846
Practice Address - Country:US
Practice Address - Phone:432-221-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1187517367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered