Healthcare Provider Details

I. General information

NPI: 1225482862
Provider Name (Legal Business Name): KYLIE ANN RYAN BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KYLIE ANN BAIMA

II. Dates (important events)

Enumeration Date: 04/20/2016
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1141 MILITARY AVE
BAXTER SPRINGS KS
66713-1509
US

IV. Provider business mailing address

1141 MILITARY AVE
BAXTER SPRINGS KS
66713-1509
US

V. Phone/Fax

Practice location:
  • Phone: 620-330-9036
  • Fax: 620-206-2514
Mailing address:
  • Phone: 620-330-9036
  • Fax: 620-206-2514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2022041103
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number00854
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-60014
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: