MEDICARE: MAYA-LIS WRIGHT CN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133N00000X	Nutritionist	246101	KY

General Provider Information

NPI Number	:	1558167908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAYA-LIS WRIGHT CN

Provider Business Mailing Address
First Line	:	302 GENERAL SMITH DR
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-8886
Country	:	US
Telephone Number	:	859-358-0568
Fax Number	:

Provider Business Practice Location Address
First Line	:	302 GENERAL SMITH DR
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-8886
Country	:	US
Telephone Number	:	859-358-0568
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2025
Last Update Date	:	02/24/2025

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