Provider Demographics
NPI:1043804651
Name:KIE, RYANNE
Entity Type:Individual
Prefix:
First Name:RYANNE
Middle Name:
Last Name:KIE
Suffix:
Gender:F
Credentials:
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 421
Mailing Address - Street 2:
Mailing Address - City:NEW LAGUNA
Mailing Address - State:NM
Mailing Address - Zip Code:87038-0421
Mailing Address - Country:US
Mailing Address - Phone:505-974-0724
Mailing Address - Fax:
Practice Address - Street 1:3 ARROWHEAD RD.
Practice Address - Street 2:
Practice Address - City:LAGUNA
Practice Address - State:NM
Practice Address - Zip Code:87026
Practice Address - Country:US
Practice Address - Phone:505-974-0724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician