Provider Demographics
NPI:1326471731
Name:RAGLAND, KUTISTIA DIANE (ARRT (R) (M))
Entity Type:Individual
Prefix:
First Name:KUTISTIA
Middle Name:DIANE
Last Name:RAGLAND
Suffix:
Gender:F
Credentials:ARRT (R) (M)
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 20863
Mailing Address - Street 2:
Mailing Address - City:BARRIGADA
Mailing Address - State:GU
Mailing Address - Zip Code:96921-0863
Mailing Address - Country:US
Mailing Address - Phone:671-688-2540
Mailing Address - Fax:
Practice Address - Street 1:PSC 490 BX 7716
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96538
Practice Address - Country:US
Practice Address - Phone:671-344-9658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3161792471M2300X
FL1419132471M2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471M2300XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMammography