Provider Demographics
NPI:1225174576
Name:WRIGHT, MANDY R (FNP)
Entity Type:Individual
Prefix:MRS
First Name:MANDY
Middle Name:R
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 ASHBY ST STE B
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-5154
Mailing Address - Country:US
Mailing Address - Phone:830-303-9400
Mailing Address - Fax:830-303-9420
Practice Address - Street 1:601 PERSON STREET
Practice Address - Street 2:
Practice Address - City:STOCKDALE
Practice Address - State:TX
Practice Address - Zip Code:78160
Practice Address - Country:US
Practice Address - Phone:830-996-3701
Practice Address - Fax:830-996-3749
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX634624363L00000X
TXAP110180363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G2737Medicare ID - Type Unspecified
TXP31684Medicare UPIN