Provider Demographics
NPI:1326066341
Name:WRIGHT, KELLY LYNN (MD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LYNN
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:LYNN
Other - Last Name:TUMILTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:885 KEMPSVILLE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3800
Mailing Address - Country:US
Mailing Address - Phone:757-461-6342
Mailing Address - Fax:757-963-6158
Practice Address - Street 1:885 KEMPSVILLE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3800
Practice Address - Country:US
Practice Address - Phone:757-461-6342
Practice Address - Fax:757-963-6158
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01011237474208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10255911Medicaid
5283777OtherCIGNA
7363715OtherAETNA
VA196806OtherANTHEM
10003003OtherOPTIMA INSURANCE
VA127893Medicare UPIN