1922483635 NPI number — KILEY RAMER BCBA

Table of content: KILEY RAMER BCBA (NPI 1922483635)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922483635 NPI number — KILEY RAMER BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAMER
Provider First Name:
KILEY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BCBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HERNANDEZ
Provider Other First Name:
KILEY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MAIDEN NAME
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1922483635
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/04/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6910 N MAIN ST BLDG 13 C BOX 51
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRANGER
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46530-2635
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-217-1624
Provider Business Mailing Address Fax Number:
574-889-9524

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6910 N MAIN ST BLDG 13C51
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRANGER
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-217-1624
Provider Business Practice Location Address Fax Number:
574-889-9524
Provider Enumeration Date:
07/23/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  1-15-19305 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1-15-19305 . This is a "BCBA" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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