Provider Demographics
NPI:1073972527
Name:WYNN, KYLA JONES (NP)
Entity Type:Individual
Prefix:
First Name:KYLA
Middle Name:JONES
Last Name:WYNN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5900 HIGHWAY 225
Mailing Address - Street 2:MEDICAL BUILDING
Mailing Address - City:DEER PARK
Mailing Address - State:TX
Mailing Address - Zip Code:77536-2434
Mailing Address - Country:US
Mailing Address - Phone:713-246-6932
Mailing Address - Fax:713-246-7811
Practice Address - Street 1:5900 HIGHWAY 225
Practice Address - Street 2:MEDICAL BUILDING
Practice Address - City:DEER PARK
Practice Address - State:TX
Practice Address - Zip Code:77536-2434
Practice Address - Country:US
Practice Address - Phone:713-246-6932
Practice Address - Fax:713-246-7811
Is Sole Proprietor?:No
Enumeration Date:2016-02-12
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP121958364SX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SX0106XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistOccupational Health