Provider Demographics
NPI:1003898198
Name:WRIGHT, JEFFREY A (PA-C)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:A
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 912042
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84791-2042
Mailing Address - Country:US
Mailing Address - Phone:435-215-0228
Mailing Address - Fax:435-656-2828
Practice Address - Street 1:2891 E MALL DRIVE
Practice Address - Street 2:STE 101
Practice Address - City:ST. GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7049
Practice Address - Country:US
Practice Address - Phone:435-656-2424
Practice Address - Fax:435-656-2828
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA-C97363AM0700X, 363AM0700X
UT285002-1206363A00000X
NVPA985363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVP55752Medicare UPIN