Provider Demographics
NPI:1871687707
Name:WRIGHT, JASON CORBEN (PA)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:CORBEN
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:989 RIBAUT RD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-5472
Mailing Address - Country:US
Mailing Address - Phone:843-522-7600
Mailing Address - Fax:843-522-7612
Practice Address - Street 1:2 GREENWOOD DR
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29928-4538
Practice Address - Country:US
Practice Address - Phone:843-341-3232
Practice Address - Fax:843-341-3234
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA335363AM0700X
SC1388363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCE34114Medicare UPIN