Provider Demographics
NPI:1740805134
Name:WRIGHT, KYASHIRAH BARNER (NP-C)
Entity Type:Individual
Prefix:
First Name:KYASHIRAH
Middle Name:BARNER
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 ROOSEVELT ST
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31503-4842
Mailing Address - Country:US
Mailing Address - Phone:912-281-9119
Mailing Address - Fax:
Practice Address - Street 1:1720 OLD REYNOLDS ST
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-1036
Practice Address - Country:US
Practice Address - Phone:912-283-1359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN230453363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner