Healthcare Provider Details

I. General information

NPI: 1598508657
Provider Name (Legal Business Name): KIRA PRYOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 06/17/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7808 PACIFIC AVE STE 9
TACOMA WA
98408-7039
US

IV. Provider business mailing address

2765 WINDSOR LN SW APT 2035
TUMWATER WA
98512-8380
US

V. Phone/Fax

Practice location:
  • Phone: 509-321-7591
  • Fax:
Mailing address:
  • Phone: 253-363-7864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberCB61158345
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: