Healthcare Provider Details

I. General information

NPI: 1063334589
Provider Name (Legal Business Name): MCKAYLA GABRIEL WRIGHT PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 BOND AVE
CAHOKIA HEIGHTS IL
62207-2326
US

IV. Provider business mailing address

5900 BOND AVE
CAHOKIA HEIGHTS IL
62207-2326
US

V. Phone/Fax

Practice location:
  • Phone: 618-332-3060
  • Fax: 618-332-4019
Mailing address:
  • Phone: 618-332-3060
  • Fax: 618-332-4019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number041.504416
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: