Provider Demographics
NPI:1184258279
Name:WALKER, RYAN (PA)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:WALKER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:382 NE 191ST ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-3899
Mailing Address - Country:US
Mailing Address - Phone:305-908-1115
Mailing Address - Fax:305-675-3135
Practice Address - Street 1:3250 MARY ST STE 300
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-5293
Practice Address - Country:US
Practice Address - Phone:305-908-1115
Practice Address - Fax:305-675-3135
Is Sole Proprietor?:No
Enumeration Date:2020-02-27
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant