Provider Demographics
NPI:1932507647
Name:DONOVAN-WRIGHT, KELLI (MD)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:DONOVAN-WRIGHT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KELLEY
Other - Middle Name:
Other - Last Name:DONOVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13935 BANDIX RD SE
Mailing Address - Street 2:
Mailing Address - City:OLALLA
Mailing Address - State:WA
Mailing Address - Zip Code:98359-9414
Mailing Address - Country:US
Mailing Address - Phone:559-307-0298
Mailing Address - Fax:
Practice Address - Street 1:51 BIRDSALL AVE
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-2453
Practice Address - Country:US
Practice Address - Phone:559-307-0298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-11
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT68049207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine