Provider Demographics
NPI:1265460505
Name:WRIGHT, KELLI L (PAC)
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:L
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:LYNN
Other - Last Name:TOWNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:915 GESSNER RD STE 400
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2667
Mailing Address - Country:US
Mailing Address - Phone:713-486-6400
Mailing Address - Fax:713-461-0190
Practice Address - Street 1:915 GESSNER RD STE 400
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2667
Practice Address - Country:US
Practice Address - Phone:713-486-6400
Practice Address - Fax:713-461-0190
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004877363AS0400X
TXPA03635363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAQ25960Medicare UPIN
WA8856960Medicare ID - Type Unspecified
WA8857626Medicare ID - Type Unspecified