Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Gannon Ryan Nyquist, PA-C

Individual provider Physician Assistant · NPI 1134793169

Gannon Ryan Nyquist, PA-C is a Physician Assistant in Vallejo, California. Qualified in 2022, 4 years ago. Practices with Providence Health and Services Oregon, a 164-clinician group, works from 2 locations, accepts Medicare assignment and offers telehealth. Licensed in Oregon.

Years since qualifying
4
Licensed in
OR
In the registry since
2021
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

1310 Club Dr
Vallejo, CA 94592-1187
Phone: (707) 638-5809
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 827 Spring St, Medford, OR 97504-6104 — (541) 732-7600

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA213297 (OR)
Physician Assistant Taxonomy 363A00000X

Record details

NPI number1134793169
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedMay 14, 2021
Last updated in NPPESSeptember 12, 2022
Certification dateSeptember 12, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Providence Health And Services Oregon — 164 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations2 on file with Medicare

Other providers in Vallejo