MEDICARE: MS. KIAHNA RALPH RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	925441	TX
2	163WI0500X	Infusion Therapy Registered Nurse	RN68919	ME

General Provider Information

NPI Number	:	1134666050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KIAHNA RALPH RN

Provider Business Mailing Address
First Line	:	13103 MOSSY BARK LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77041-4204
Country	:	US
Telephone Number	:	704-414-0511
Fax Number	:

Provider Business Practice Location Address
First Line	:	5211 PINEWILDE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77066-2825
Country	:	US
Telephone Number	:	704-414-0511
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2017
Last Update Date	:	08/05/2020

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