Provider Demographics
NPI:1326058660
Name:WRIGHT, KIMBERLY LENORE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:LENORE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4735 OGLETOWN STANTON RD STE 3301
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-7021
Mailing Address - Country:US
Mailing Address - Phone:302-623-4370
Mailing Address - Fax:302-623-4375
Practice Address - Street 1:4735 OGLETOWN STANTON RD STE 3301
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-7021
Practice Address - Country:US
Practice Address - Phone:302-623-4370
Practice Address - Fax:302-623-4375
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052515363A00000X, 363AM0700X
DEC5-0011411363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1554129OtherGATEWAY-WMG
PA2109234OtherHIGHMARK BLUE SHIELD
PA105473Medicare PIN
PA2109234OtherHIGHMARK BLUE SHIELD