Healthcare Provider Details

I. General information

NPI: 1851802912
Provider Name (Legal Business Name): KYLIE WRIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2017
Last Update Date: 10/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 E 230 N BLDG A
ST. GEORGE UT
84790
US

IV. Provider business mailing address

7434 S STATE ST
MIDVALE UT
84047-2014
US

V. Phone/Fax

Practice location:
  • Phone: 435-720-8876
  • Fax:
Mailing address:
  • Phone: 801-456-9955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: