Provider Demographics
NPI:1972872703
Name:VANSICKLE, RYAN (MD, PHARMD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:VANSICKLE
Suffix:
Gender:M
Credentials:MD, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 CARTER ST
Mailing Address - Street 2:
Mailing Address - City:BERRYVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72616-4303
Mailing Address - Country:US
Mailing Address - Phone:870-423-3355
Mailing Address - Fax:
Practice Address - Street 1:214 CARTER ST
Practice Address - Street 2:
Practice Address - City:BERRYVILLE
Practice Address - State:AR
Practice Address - Zip Code:72616-4303
Practice Address - Country:US
Practice Address - Phone:870-423-3355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-22
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN119791183500000X
IAR-9718207L00000X
ARE-13914207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No183500000XPharmacy Service ProvidersPharmacist
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology