Provider Demographics
NPI:1518256197
Name:PATRICK, KYNA WYN (KYNA PATRICK)
Entity Type:Individual
Prefix:
First Name:KYNA
Middle Name:WYN
Last Name:PATRICK
Suffix:
Gender:F
Credentials:KYNA PATRICK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 W PARMER LN
Mailing Address - Street 2:APT 1417
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78727-3909
Mailing Address - Country:US
Mailing Address - Phone:512-393-9955
Mailing Address - Fax:
Practice Address - Street 1:5400 W PARMER LN
Practice Address - Street 2:APT 1417
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78727-3909
Practice Address - Country:US
Practice Address - Phone:512-393-9955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10952649174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN