MEDICARE: NICHOLAS MICHAEL REGGIE WRIGHT

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	95037178	CA

General Provider Information

NPI Number	:	1407729775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS MICHAEL REGGIE WRIGHT

Provider Business Mailing Address
First Line	:	21600 OXNARD ST STE 710
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-4976
Country	:	US
Telephone Number	:	323-842-4240
Fax Number	:	818-741-2811

Provider Business Practice Location Address
First Line	:	21600 OXNARD ST STE 710
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-4976
Country	:	US
Telephone Number	:	323-842-4240
Fax Number	:	818-741-2811

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

Provider Enumeration Date	:	09/24/2025
Last Update Date	:	03/09/2026

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