Active NPI
Tracy Ann Reagan Kiele, LMFT
- Marriage & Family Therapist
- Ruidoso, NM
National Provider Identifier
1790714822
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 0147561
- Practice address
- 1400 Sudderth
Ruidoso, NM 88345 - Phone
- (575) 630-0571
- Fax
- (575) 630-0574
- NPI assigned
- Jul 1, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 422 | CO | |
| Marriage & Family Therapist | 106H00000X | 0147561 | NM | Primary |
Addresses
Primary practice location
1400 Sudderth
Ruidoso, NM 88345
Mailing address
1320 S. Solano
Las Cruces, NM 88001
Phone (575) 527-7900
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 18677037 | Medicaid | NM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0147561 | NM | MD | Marriage & Family Therapist |
| 422 | CO | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151712000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1395964800000",
"number": "1790714822",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1320 S. SOLANO",
"city": "LAS CRUCES",
"state": "NM",
"postal_code": "88001",
"telephone_number": "575-527-7900",
"fax_number": "575-571-4872"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1400 SUDDERTH",
"city": "RUIDOSO",
"state": "NM",
"postal_code": "88345",
"telephone_number": "575-630-0571",
"fax_number": "575-630-0574"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REAGAN KIELE",
"first_name": "TRACY",
"middle_name": "ANN",
"credential": "LMFT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-01",
"last_updated": "2014-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CO",
"license": "422",
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "NM",
"license": "0147561",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "18677037",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ruidoso, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.