Provider Demographics
NPI:1326515529
Name:WRIGHT, KELSEY LEIGH (PA)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:LEIGH
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1818 WALLACE CT STE 301
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-2462
Mailing Address - Country:US
Mailing Address - Phone:270-842-1999
Mailing Address - Fax:270-904-4113
Practice Address - Street 1:2915 NEW HARTFORD RD
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1323
Practice Address - Country:US
Practice Address - Phone:270-842-1999
Practice Address - Fax:270-904-4113
Is Sole Proprietor?:No
Enumeration Date:2018-10-26
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
363A00000X
KYPA2665363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant