Provider Demographics
NPI:1104909688
Name:WRIGHT, OTIS D (NP)
Entity type:Individual
Prefix:
First Name:OTIS
Middle Name:D
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:NP
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Mailing Address - Street 1:7005 MIRA LOMA LN
Mailing Address - Street 2:SUITE 102
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-1411
Mailing Address - Country:US
Mailing Address - Phone:512-795-4344
Mailing Address - Fax:512-928-9466
Practice Address - Street 1:7005 MIRA LOMA LN
Practice Address - Street 2:SUITE 102
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-1411
Practice Address - Country:US
Practice Address - Phone:512-795-4344
Practice Address - Fax:512-928-9466
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2017-01-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CANP 16852363LG0600X
TXAP115175363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP115175OtherNP LICENSE
CANP16852OtherNP LICENSE