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General NPI Number Information
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NPI Number | 1346562535
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Entity Type | Individual
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Provider Name | KRISTEN LAUREN WRIGHT ATC
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Gender | Female
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Dates
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Enumeration Date | 02/16/2010
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Last Update Date | 02/09/2011
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Provider Practice Location Address
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Address Line | 1325 SAN MARCO BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32207-8568
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Country | US
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Telephone | 904-858-7045
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Fax | 904-858-7047
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Provider Business Mailing Address
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Address Line | 1325 SAN MARCO BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32207-8568
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Country | US
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Telephone | 904-858-7045
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Fax | 904-858-7047
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 1374
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License Number State | NC
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