Provider Demographics
NPI:1285232777
Name:WRIGHT, KHRYSTAL (PP)
Entity Type:Individual
Prefix:
First Name:KHRYSTAL
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:PP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4016 FOXBOROUGH BLVD
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-6726
Mailing Address - Country:US
Mailing Address - Phone:229-300-5339
Mailing Address - Fax:
Practice Address - Street 1:4016 FOXBOROUGH BLVD
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-6726
Practice Address - Country:US
Practice Address - Phone:229-300-5339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor