Provider Demographics
NPI:1699094169
Name:RAPPE, KIA ELIZABETH
Entity type:Individual
Prefix:
First Name:KIA
Middle Name:ELIZABETH
Last Name:RAPPE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KIA
Other - Middle Name:ELIZABETH
Other - Last Name:KINNAMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1879
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74465-1879
Mailing Address - Country:US
Mailing Address - Phone:918-441-0692
Mailing Address - Fax:
Practice Address - Street 1:619 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-4431
Practice Address - Country:US
Practice Address - Phone:918-682-2491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-24
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health