MEDICARE: MRS. KYNDRA P WRIGHT CRNP

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	363L00000X	Nurse Practitioner	1-140446	AL

General Provider Information

NPI Number	:	1376045963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KYNDRA P WRIGHT CRNP

Provider Business Mailing Address
First Line	:	315 W FORT WILLIAMS ST STE 100
Second Line	:
City	:	SYLACAUGA
State	:	AL
Zip	:	35150-2433
Country	:	US
Telephone Number	:	256-249-6995
Fax Number	:	256-245-6992

Provider Business Practice Location Address
First Line	:	315 W FORT WILLIAMS ST STE 100
Second Line	:
City	:	SYLACAUGA
State	:	AL
Zip	:	35150-2433
Country	:	US
Telephone Number	:	256-249-6995
Fax Number	:	256-245-6992

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

Provider Enumeration Date	:	02/28/2018
Last Update Date	:	02/28/2018

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