Provider Demographics
NPI:1003054859
Name:RYE, KATHLEEN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:
Last Name:RYE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3768
Mailing Address - Street 2:234 CODY LANE
Mailing Address - City:BASALT
Mailing Address - State:CO
Mailing Address - Zip Code:81621-3768
Mailing Address - Country:US
Mailing Address - Phone:970-927-6650
Mailing Address - Fax:970-927-6659
Practice Address - Street 1:234 CODY LN
Practice Address - Street 2:
Practice Address - City:BASALT
Practice Address - State:CO
Practice Address - Zip Code:81621-9106
Practice Address - Country:US
Practice Address - Phone:970-927-6650
Practice Address - Fax:970-927-6659
Is Sole Proprietor?:No
Enumeration Date:2009-02-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO83962363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MM0491679OtherDEA