Provider Demographics
NPI:1881882306
Name:RIFE, KIRA A (NA)
Entity type:Individual
Prefix:MISS
First Name:KIRA
Middle Name:A
Last Name:RIFE
Suffix:
Gender:F
Credentials:NA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:656 OLD PINEY RD
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37803-3202
Mailing Address - Country:US
Mailing Address - Phone:865-681-6576
Mailing Address - Fax:
Practice Address - Street 1:301 MCGHEE ST
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37801-6811
Practice Address - Country:US
Practice Address - Phone:865-983-4582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN121780172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker