Provider Demographics
NPI:1225482862
Name:RYAN, KYLIE ANN (BCBA)
Entity type:Individual
Prefix:
First Name:KYLIE
Middle Name:ANN
Last Name:RYAN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:KYLIE
Other - Middle Name:ANN
Other - Last Name:BAIMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2404 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:COFFEYVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67337-2931
Mailing Address - Country:US
Mailing Address - Phone:620-330-9036
Mailing Address - Fax:620-206-2514
Practice Address - Street 1:2404 W 8TH ST
Practice Address - Street 2:
Practice Address - City:COFFEYVILLE
Practice Address - State:KS
Practice Address - Zip Code:67337-2931
Practice Address - Country:US
Practice Address - Phone:620-330-9036
Practice Address - Fax:620-206-2514
Is Sole Proprietor?:No
Enumeration Date:2016-04-20
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
RBT-19-82078106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst