Individual provider · Type 1 NPI

Kynnadi Ayri Wallace

Student in an Organized Health Care Education/Training Program · Stephenville, TX

NPI number 1659266641 Active

Practice location

1333 W Washington St
Stephenville, TX 76401-4168

Call (254) 968-9186 Map

Mailing address

504 W Clover Park Dr
Fort Worth, TX 76140-6545

Specialties and licenses

TaxonomyCodeLicense
Athletic Trainer 2255A2300XNone listed
Student in an Organized Health Care Education/Training Program Primary 390200000XNone listed

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1659266641

Kynnadi Ayri Wallace's National Provider Identifier is 1659266641, issued on Jun 10, 2025. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Stephenville, TX. The record was last updated on Jun 10, 2025.