Healthcare Provider Details

I. General information

NPI: 1326675166
Provider Name (Legal Business Name): KENDRICK WRIGHT FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 09/22/2023
Certification Date: 09/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 W GLENDALE AVE
PHOENIX AZ
85021-8948
US

IV. Provider business mailing address

PO BOX 20610
MESA AZ
85277-0610
US

V. Phone/Fax

Practice location:
  • Phone: 480-985-1093
  • Fax: 480-296-7665
Mailing address:
  • Phone: 480-985-1093
  • Fax: 480-296-7665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number239534
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number239534
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: