MEDICARE: KATHRYN CHRISTINE WRIGHT FNP-BC

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	363LP2300X	Primary Care Nurse Practitioner	4704339804	MI
2	163W00000X	Registered Nurse	4704339804	MI

General Provider Information

NPI Number	:	1962028258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN CHRISTINE WRIGHT FNP-BC

Provider Business Mailing Address
First Line	:	1020 4TH AVE
Second Line	:
City	:	LAKE ODESSA
State	:	MI
Zip	:	48849-1004
Country	:	US
Telephone Number	:	616-374-8881
Fax Number	:	616-374-4220

Provider Business Practice Location Address
First Line	:	1020 4TH AVE
Second Line	:
City	:	LAKE ODESSA
State	:	MI
Zip	:	48849-1004
Country	:	US
Telephone Number	:	616-374-8881
Fax Number	:	616-374-4220

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

Provider Enumeration Date	:	06/22/2020
Last Update Date	:	03/19/2025

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