MEDICARE: MS. KENDALL DENISE WINES APRN, FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	774690	TX

General Provider Information

NPI Number	:	1366729311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KENDALL DENISE WINES APRN, FNP-C

Provider Business Mailing Address
First Line	:	785 ELKRIDGE LANDING RD STE 300
Second Line	:
City	:	LINTHICUM
State	:	MD
Zip	:	21090-2958
Country	:	US
Telephone Number	:	443-275-9800
Fax Number	:

Provider Business Practice Location Address
First Line	:	4150 INTERNATIONAL PLZ STE 270
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-4892
Country	:	US
Telephone Number	:	443-275-9800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2011
Last Update Date	:	04/06/2026

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