Individual
KATHY RYALS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.N.
Contact information
Practice address
515 N 16TH ST, PAYETTE, ID 83661-2774
(208) 642-6416
(208) 642-2829
Mailing address
515 N 16TH ST, PAYETTE, ID 83661-2774
(208) 642-6416
(208) 642-2829
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
N 32991
ID
364SP0808X
Psychiatric/Mental Health Clinical Nurse Specialist
Primary
N 32991
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010018824
BLUESHIELD
—
01
—
HW348
BLUE CROSS OF IDAHO
ID
Enumeration date
01/19/2012
Last updated
01/19/2012
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