Provider Demographics
NPI:1235169665
Name:WRIGHT, VERNON ALVIN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:VERNON
Middle Name:ALVIN
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2402 FRIST BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4838
Mailing Address - Country:US
Mailing Address - Phone:772-466-1113
Mailing Address - Fax:772-466-1103
Practice Address - Street 1:2402 FRIST BLVD STE 204
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4838
Practice Address - Country:US
Practice Address - Phone:772-466-1113
Practice Address - Fax:772-466-1103
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA2905363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL970021974Medicare PIN
FL970021974Medicare PIN