Provider Demographics
NPI:1922986744
Name:LISH, RYAN WESLEY (PA)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:WESLEY
Last Name:LISH
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:531 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-6210
Mailing Address - Country:US
Mailing Address - Phone:208-244-4013
Mailing Address - Fax:
Practice Address - Street 1:1309 BLUE LAKES BLVD N
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3310
Practice Address - Country:US
Practice Address - Phone:208-933-4442
Practice Address - Fax:208-933-4273
Is Sole Proprietor?:No
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical