Provider Demographics
NPI:1326141474
Name:WRIGHT, KELLY CUTSHALL (PA)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:CUTSHALL
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:LAUREN
Other - Last Name:CUTSHALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:7112 GENTLE OAK DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-1896
Mailing Address - Country:US
Mailing Address - Phone:512-508-8320
Mailing Address - Fax:512-488-1745
Practice Address - Street 1:2111 KRAMER LN STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-4032
Practice Address - Country:US
Practice Address - Phone:512-508-8320
Practice Address - Fax:512-488-1745
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04712363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ69280Medicare UPIN
TX8G5515Medicare ID - Type Unspecified