Provider Demographics
NPI:1427210061
Name:FUSON, RYAN J (FNP-C, PMHNP-B, DC)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:J
Last Name:FUSON
Suffix:
Gender:M
Credentials:FNP-C, PMHNP-B, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 GATTIS SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-7428
Mailing Address - Country:US
Mailing Address - Phone:866-389-2727
Mailing Address - Fax:
Practice Address - Street 1:1855 GATTIS SCHOOL RD
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-7428
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID5661479363L00000X
NV881818363L00000X
MI4704419881363L00000X
COC-RXN.0101849-C-NP363LF0000X
WY55235363LF0000X, 363LP0808X
NE115600363LF0000X, 363LP0808X
AR230539363LF0000X, 363LP0808X
IN71015744A363LF0000X, 363LP0808X
IAA181447363LF0000X
TX1048921363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD486GMedicare PIN