Provider Demographics
NPI:1104652767
Name:RUPPEL, KIRSTEN MCKAYLA
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:MCKAYLA
Last Name:RUPPEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 244
Mailing Address - Street 2:
Mailing Address - City:BIG STONE GAP
Mailing Address - State:VA
Mailing Address - Zip Code:24219-0244
Mailing Address - Country:US
Mailing Address - Phone:606-308-9508
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 244
Practice Address - Street 2:
Practice Address - City:BIG STONE GAP
Practice Address - State:VA
Practice Address - Zip Code:24219-0244
Practice Address - Country:US
Practice Address - Phone:606-308-9508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYRBT-23-296533106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician