Provider Demographics
NPI:1437415825
Name:WRIGHT, KYLEE SUZANNE (IDMT)
Entity Type:Individual
Prefix:MISS
First Name:KYLEE
Middle Name:SUZANNE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10215 TIGER BAY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-4257
Mailing Address - Country:US
Mailing Address - Phone:210-482-0955
Mailing Address - Fax:
Practice Address - Street 1:10215 TIGER BAY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-4257
Practice Address - Country:US
Practice Address - Phone:210-482-0955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians