Healthcare Provider Details

I. General information

NPI: 1316708258
Provider Name (Legal Business Name): TENA KERLEY WRIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2024
Last Update Date: 03/04/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 ROYCE ST
PENSACOLA FL
32503-2464
US

IV. Provider business mailing address

1103 VIA DE LUNA DR
PENSACOLA BEACH FL
32561-2265
US

V. Phone/Fax

Practice location:
  • Phone: 448-202-1580
  • Fax:
Mailing address:
  • Phone: 448-202-1580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License NumberCRT63937
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: