Provider Demographics
NPI:1114161957
Name:RYAN, KATHLEEN CHRISTINA (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:CHRISTINA
Last Name:RYAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KATHLEEN
Other - Middle Name:CHRISTINA
Other - Last Name:FLAHERTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:600 CAISSON HILL RD
Mailing Address - Street 2:
Mailing Address - City:FORT RILEY
Mailing Address - State:KS
Mailing Address - Zip Code:66442-7037
Mailing Address - Country:US
Mailing Address - Phone:785-240-7227
Mailing Address - Fax:
Practice Address - Street 1:600 CAISSON HILL RD
Practice Address - Street 2:
Practice Address - City:FORT RILEY
Practice Address - State:KS
Practice Address - Zip Code:66442-7037
Practice Address - Country:US
Practice Address - Phone:785-240-7227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-23
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA61451207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine