Provider Demographics
NPI:1700867637
Name:WRIGHT, MICHELLE MARIE (PA-C, MMSC)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:MARIE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:PA-C, MMSC
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:MARIE
Other - Last Name:MA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C, MMSC
Mailing Address - Street 1:1505 ACACIA ST
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-5138
Mailing Address - Country:US
Mailing Address - Phone:214-729-4743
Mailing Address - Fax:
Practice Address - Street 1:4400 LONG PRAIRIE RD
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1892
Practice Address - Country:US
Practice Address - Phone:214-729-4743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15876363AS0400X
TXPA04588363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ71847Medicare UPIN
TX8G7946Medicare PIN