Kelly Ryan, PMHNP-BC, APRN-CNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

6401017335 Issued in MI

Practice address

3155 Logan Valley Rd
Traverse City, MI 49684-4772

Phone

(402) 677-9083

NPI assigned

Aug 30, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH, MI2 enrollments

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.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Farrellco Inc

  • Clinical Psychologist
  • Cincinnati, OH
  • NPI 1578993572
  Medicare reassignment NPD
• Wellness Card LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Dayton, OH
  • NPI 1558678151
  Medicare reassignment NPD
• Woodman Primary Care LLC

  • Cardiovascular Disease Physician
  • Dayton, OH
  • NPI 1346582608
  Medicare reassignment NPD
• Traverse Health Clinic and Coalition

  • Federally Qualified Health Center (FQHC)
  • Traverse City, MI
  • NPI 1467632059
  NPD
• Lakeview Counseling P.C.

  • Community/Behavioral Health Agency
  • Traverse City, MI
  • NPI 1316009012
  NPD (past)

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

{
    "created_epoch": "1472515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780358400000",
    "number": "1134675192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3155 LOGAN VALLEY RD",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496844772",
            "telephone_number": "402-677-9083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3155 LOGAN VALLEY RD",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496844772",
            "telephone_number": "402-677-9083"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "333 W Grandview Pkwy Ste 403",
            "address_purpose": "LOCATION",
            "city": "Traverse City",
            "state": "MI",
            "postal_code": "496842298",
            "country_code": "US",
            "telephone_number": "231-929-0300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RYAN",
        "first_name": "KELLY",
        "credential": "PMHNP-BC, APRN-CNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-08-30",
        "last_updated": "2026-06-02",
        "certification_date": "2026-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MI",
            "license": "6401017335",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mariah Lynn Russell
• Naila Christine Russell, DNP, FNP-BC
• Samantha M Ruth, MA LLP
• Ryan a Paulson DDS PC
• Jenifer Ryan, LMSW
• Shoba Sosale-Berkuchel Ryan, DNP, PMHNP-BC
• Tara J Rybicki, R.D.
• Kristen Ryder, SSP, LLMSW-C
• Valerie Smith Rye, MMT
• Linda Rysberg, SLP

• Psychiatric/Mental Health Nurse Practitioner in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Psychiatric/Mental Health Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.