Provider Demographics
NPI:1073091245
Name:WRIGHT, JOSHUA DEWAYNE (PA)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:DEWAYNE
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2975 E BROAD ST STE 200
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-9186
Mailing Address - Country:US
Mailing Address - Phone:806-447-5311
Mailing Address - Fax:806-447-3090
Practice Address - Street 1:2975 E BROAD ST STE 200
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063
Practice Address - Country:US
Practice Address - Phone:806-447-5311
Practice Address - Fax:806-447-3090
Is Sole Proprietor?:No
Enumeration Date:2018-07-31
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA12138363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant