Provider Demographics
NPI:1114099231
Name:WRIGHT, BLAIR PATRICK (CRNA)
Entity Type:Individual
Prefix:MR
First Name:BLAIR
Middle Name:PATRICK
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:CRNA
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 515
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-0515
Mailing Address - Country:US
Mailing Address - Phone:304-736-6126
Mailing Address - Fax:
Practice Address - Street 1:2900 FIRST AVENUE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25702-1241
Practice Address - Country:US
Practice Address - Phone:304-526-1031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV50941367500000X
OH08139367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810002819Medicaid
WV550696369-00OtherWV WORKERS COMP PROVIDER
WV001710226OtherWV BLUE CROSS PROVIDER #
WV8233971Medicare PIN
WV3810002819Medicaid