Provider Demographics
NPI:1003838335
Name:WRIGHT, KENDALL MERRITT (MD)
Entity Type:Individual
Prefix:
First Name:KENDALL
Middle Name:MERRITT
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 W 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-2504
Mailing Address - Country:US
Mailing Address - Phone:620-343-6800
Mailing Address - Fax:620-341-7821
Practice Address - Street 1:1301 W 12TH AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-2587
Practice Address - Country:US
Practice Address - Phone:620-343-2376
Practice Address - Fax:620-343-0095
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-15171207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS103207OtherBC/BS
KS100207160CMedicaid
KSP00057491OtherMEDICARE RAILROAD
KS100207160CMedicaid
KSB69378Medicare UPIN