Healthcare Provider Details

I. General information

NPI: 1134666050
Provider Name (Legal Business Name): KIAHNA RALPH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2017
Last Update Date: 08/05/2020
Certification Date: 08/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5211 PINEWILDE DR
HOUSTON TX
77066-2825
US

IV. Provider business mailing address

13103 MOSSY BARK LN
HOUSTON TX
77041-4204
US

V. Phone/Fax

Practice location:
  • Phone: 704-414-0511
  • Fax:
Mailing address:
  • Phone: 704-414-0511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number925441
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License NumberRN68919
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: