Provider Demographics
NPI:1255629598
Name:WRIGHT, PAMELA M (MED)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:M
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5132 NW 20TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73127-2312
Mailing Address - Country:US
Mailing Address - Phone:405-640-7899
Mailing Address - Fax:
Practice Address - Street 1:5132 NW 20TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73127-2312
Practice Address - Country:US
Practice Address - Phone:405-640-7899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-20
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK4056407899Medicaid