Provider Demographics
NPI:1689983199
Name:SMUTNY, KYLE RYAN
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:RYAN
Last Name:SMUTNY
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 1:612 4TH ST
Mailing Address - Street 2:
Mailing Address - City:ORLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95963-1345
Mailing Address - Country:US
Mailing Address - Phone:530-865-1622
Mailing Address - Fax:530-865-7073
Practice Address - Street 1:612 4TH ST
Practice Address - Street 2:
Practice Address - City:ORLAND
Practice Address - State:CA
Practice Address - Zip Code:95963-1345
Practice Address - Country:US
Practice Address - Phone:530-865-1622
Practice Address - Fax:530-865-7073
Is Sole Proprietor?:No
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator