Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | OS13949 | FL |
Y | 111NI0900X | Internist | OS13949 | FL |
N | 207RI0011X | Interventional Cardiology | O-1589 | ID |
NPI | 1093058687 |
---|---|
Provider Name | Katie Lynn Ryder |
First Address | Idaho Falls, ID 83404-7554 |
Second Address | Idaho Falls, ID 83404-7554 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2013 |
Last Update Date | 29/12/2021 |