Healthcare Provider Details

I. General information

NPI: 1073972527
Provider Name (Legal Business Name): KYLA JONES WYNN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2016
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1293 ELDRIDGE PKWY # W1084
HOUSTON TX
77077-1670
US

IV. Provider business mailing address

1293 ELDRIDGE PKWY # W1084
HOUSTON TX
77077-1670
US

V. Phone/Fax

Practice location:
  • Phone: 832-486-1483
  • Fax: 713-570-5816
Mailing address:
  • Phone: 832-486-1483
  • Fax: 713-570-5816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License NumberAP121958
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: