Provider Demographics
NPI:1689187205
Name:WRIGHT, KYLIE ANNE (PMHNP)
Entity type:Individual
Prefix:
First Name:KYLIE
Middle Name:ANNE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1934 OLD GALLOWS RD STE 350
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-4050
Mailing Address - Country:US
Mailing Address - Phone:703-994-1232
Mailing Address - Fax:571-707-4004
Practice Address - Street 1:1934 OLD GALLOWS RD STE 350
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-4050
Practice Address - Country:US
Practice Address - Phone:703-994-1232
Practice Address - Fax:571-404-7007
Is Sole Proprietor?:No
Enumeration Date:2017-11-06
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC003087363LP0808X
VA0024175263363LP0808X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner