Individual provider Active NPI

Ryan Penn, PA-C

  • Physician Assistant
  • Puyallup, WA
National Provider Identifier
1083586499
Registry record updated Aug 14, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA.PA.70053189 Issued in WA
Practice address
413 29TH St NE Ste I
Puyallup, WA 98372-7154
Phone
(855) 255-1750
Fax
(855) 255-0905
NPI assigned
Sep 23, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA.PA.70053189 WA
Physician Assistant 363A00000X PA.PA.70053189 WA Primary
Surgical Physician Assistant 363AS0400X PA.PA.70053189 WA

Addresses

Primary practice location

413 29TH St NE Ste I
Puyallup, WA 98372-7154

Mailing address

PO Box 24081
Seattle, WA 98124-0081
Phone (855) 255-1750

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
United Wound Healing PS Physician Assistant PastSince Sep 29, 2024 Accepting new patients
United Wound Healing Accountable Care Consultants PLLC Physician Assistant PastSince Oct 20, 2024 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1758585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786665600000",
    "number": "1083586499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 24081",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981240081",
            "telephone_number": "855-255-1750",
            "fax_number": "855-255-0905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "413 29TH ST NE STE I",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983727154",
            "telephone_number": "855-255-1750",
            "fax_number": "855-255-0905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENN",
        "first_name": "RYAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-09-23",
        "last_updated": "2026-08-14",
        "certification_date": "2026-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA.PA.70053189",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA.PA.70053189",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WA",
            "license": "PA.PA.70053189",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Puyallup, WA

Sources for this page

Verify at the official NPI Registry.