Ryan Bourgeois, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

1010773 Issued in TX

Practice address

2917 Crocket Street
Fort Worth, TX 76107

Phone

(817) 385-4814

NPI assigned

Aug 31, 2020

Sex

Male

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1598832000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598832000000",
    "number": "1669085437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15304 SEVENTEEN LAKES BLVD",
            "city": "ROANOKE",
            "state": "TX",
            "postal_code": "762623739",
            "telephone_number": "818-209-2501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2917 CROCKET STREET",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "76107",
            "telephone_number": "817-385-4814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOURGEOIS",
        "first_name": "RYAN",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-08-31",
        "last_updated": "2020-08-31",
        "certification_date": "2020-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "1010773",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Diane Boulware, PHARMD
• Robert Matthew Boulware, PHARM.D.
• Jill Erin Bounds, MA, LPC, LMFT
• Johnica Bounds
• Bountiful Community Home Health L.L.C.
• Emily Bourget, SLP
• Aaronn Bourland
• Amy Nicole Bourland, PT
• Karen Bourland, RD, LD, CNSD
• Malek H Bouzaher

• All providers in Fort Worth, TX
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.