Healthcare Provider Details

I. General information

NPI: 1003054859
Provider Name (Legal Business Name): KATHLEEN RYE NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2009
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 CODY LN
BASALT CO
81621-9106
US

IV. Provider business mailing address

PO BOX 3768 234 CODY LANE
BASALT CO
81621-3768
US

V. Phone/Fax

Practice location:
  • Phone: 970-927-6650
  • Fax: 970-927-6659
Mailing address:
  • Phone: 970-927-6650
  • Fax: 970-927-6659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number83962
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: