Provider Demographics
NPI:1427568963
Name:WRIGHT, KENDRA MARIE (BSN, RN, CRRN, CCM)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:MARIE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:BSN, RN, CRRN, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7125 HEADLEY ST SE UNIT 196
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-4506
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7274 4 MILE RD NE
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:MI
Practice Address - Zip Code:49301-8164
Practice Address - Country:US
Practice Address - Phone:616-617-9511
Practice Address - Fax:616-617-9511
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704275755163W00000X, 163WC0400X, 163WR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163W00000XNursing Service ProvidersRegistered Nurse
No163WR0400XNursing Service ProvidersRegistered NurseRehabilitation