Healthcare Provider Details

I. General information

NPI: 1962028258
Provider Name (Legal Business Name): KATHRYN CHRISTINE WRIGHT FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2020
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 4TH AVE
LAKE ODESSA MI
48849-1004
US

IV. Provider business mailing address

1020 4TH AVE
LAKE ODESSA MI
48849-1004
US

V. Phone/Fax

Practice location:
  • Phone: 616-374-8881
  • Fax: 616-374-4220
Mailing address:
  • Phone: 616-374-8881
  • Fax: 616-374-4220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number4704339804
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704339804
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: