Provider Demographics
NPI:1043328834
Name:WRIGHT, KENNETH EARL (PAC)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:EARL
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3455 SOUTH YARROW STREET
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227
Mailing Address - Country:US
Mailing Address - Phone:303-989-5231
Mailing Address - Fax:303-989-9785
Practice Address - Street 1:3455 SOUTH YARROW STREET
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227
Practice Address - Country:US
Practice Address - Phone:303-989-5231
Practice Address - Fax:303-989-9785
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1163363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P34327Medicare UPIN