Healthcare Provider Details

I. General information

NPI: 1023851680
Provider Name (Legal Business Name): KYLER RONNER-BLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2024
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 FRONT ST STE 100
EXETER NH
03833-2727
US

IV. Provider business mailing address

11 JUNIPER LN
HAMPTON NH
03842-1521
US

V. Phone/Fax

Practice location:
  • Phone: 802-355-1423
  • Fax:
Mailing address:
  • Phone: 802-355-1423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5732
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: