Provider Demographics
NPI:1356857544
Name:KAWATA, RYAN
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:KAWATA
Suffix:
Gender:M
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 1715
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68848-1715
Mailing Address - Country:US
Mailing Address - Phone:308-237-5951
Mailing Address - Fax:308-234-4018
Practice Address - Street 1:616 W 5TH ST
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-5104
Practice Address - Country:US
Practice Address - Phone:402-463-5686
Practice Address - Fax:402-463-5686
Is Sole Proprietor?:No
Enumeration Date:2017-12-26
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health