MEDICARE: KYNA WYN PATRICK KYNA PATRICK

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	174N00000X	Lactation Consultant (Non-RN)	10952649	TX

General Provider Information

NPI Number	:	1518256197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYNA WYN PATRICK KYNA PATRICK

Provider Business Mailing Address
First Line	:	5400 W PARMER LN
Second Line	:	APT 1417
City	:	AUSTIN
State	:	TX
Zip	:	78727-3909
Country	:	US
Telephone Number	:	512-393-9955
Fax Number	:

Provider Business Practice Location Address
First Line	:	5400 W PARMER LN
Second Line	:	APT 1417
City	:	AUSTIN
State	:	TX
Zip	:	78727-3909
Country	:	US
Telephone Number	:	512-393-9955
Fax Number	:

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

Provider Enumeration Date	:	04/04/2011
Last Update Date	:	04/04/2011

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