Healthcare Provider Details

I. General information

NPI: 1174387823
Provider Name (Legal Business Name): KENYA T MADRIC-WRIGHT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2024
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 GAINSBOROUGH SQ STE 400
CHESAPEAKE VA
23320-1714
US

IV. Provider business mailing address

1301 EXECUTIVE BLVD STE 200
CHESAPEAKE VA
23320-3671
US

V. Phone/Fax

Practice location:
  • Phone: 757-842-4499
  • Fax: 757-842-4490
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001326053
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024194848
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: