Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Ryan Kingsolver, PA-C

Individual provider Physician Assistant · NPI 1164283529

Ryan Kingsolver, PA-C is a Physician Assistant in Provo, Utah. Qualified in 2023, 3 years ago. Practices with Revere Health PC, a 410-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Idaho.

Years since qualifying
3
Licensed in
ID
In the registry since
2024
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

2230 N University Pkwy Ste 9B
Provo, UT 84604-6717
Phone: (801) 375-3175
Fax: (801) 375-2818
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1296 E Polston Ave Ste C, Post Falls, ID 83854-5217 — (208) 625-6700

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 1971664 (ID)
Physician Assistant Taxonomy 363A00000X

Record details

NPI number1164283529
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedJanuary 22, 2024
Last updated in NPPESJanuary 6, 2026
Certification dateJanuary 6, 2026
Mailing address1055 N 500 W, Attn Credentialing, Provo, UT 84604-3305

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Revere Health Pc — 410 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations10 on file with Medicare

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