Provider Demographics
NPI:1093692147
Name:JAEGER-LAROCHE, KYRA MAE
Entity type:Individual
Prefix:
First Name:KYRA
Middle Name:MAE
Last Name:JAEGER-LAROCHE
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 1:415 E. ROSSER AVE
Mailing Address - Street 2:STE 113
Mailing Address - City:BISMARK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-4058
Mailing Address - Country:US
Mailing Address - Phone:701-222-6670
Mailing Address - Fax:
Practice Address - Street 1:415 E. ROSSER AVE
Practice Address - Street 2:STE 113
Practice Address - City:BISMARK
Practice Address - State:ND
Practice Address - Zip Code:58501-4058
Practice Address - Country:US
Practice Address - Phone:701-222-6670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator