Provider Demographics
NPI:1528531985
Name:DOTY, RYANE PLASTER (NP)
Entity type:Individual
Prefix:
First Name:RYANE
Middle Name:PLASTER
Last Name:DOTY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:379 WILLIAMS RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MS
Mailing Address - Zip Code:39073-7954
Mailing Address - Country:US
Mailing Address - Phone:601-919-5807
Mailing Address - Fax:844-374-4872
Practice Address - Street 1:740 AVIGNON DR STE C
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-5160
Practice Address - Country:US
Practice Address - Phone:601-937-4552
Practice Address - Fax:844-374-4872
Is Sole Proprietor?:No
Enumeration Date:2019-01-09
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902854363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS902854OtherMS LICENSE