MEDICARE: WYKINNA TRAYLOR

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	164W00000X	Licensed Practical Nurse	1013620	TX

General Provider Information

NPI Number	:	1992397574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WYKINNA TRAYLOR

Provider Business Mailing Address
First Line	:	3220 WALTON RD APT 920
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75701-0720
Country	:	US
Telephone Number	:	903-216-8993
Fax Number	:

Provider Business Practice Location Address
First Line	:	3220 WALTON RD APT 920
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75701-0720
Country	:	US
Telephone Number	:	903-216-8993
Fax Number	:

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

Provider Enumeration Date	:	02/05/2021
Last Update Date	:	02/05/2021

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Directions to “ WYKINNA TRAYLOR ” Practice Location

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