Provider Demographics
NPI:1801109848
Name:WRIGHT, LISA MARIE (PA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 587
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:TX
Mailing Address - Zip Code:78629-0587
Mailing Address - Country:US
Mailing Address - Phone:830-672-8502
Mailing Address - Fax:830-672-3035
Practice Address - Street 1:1300 CAPTAIN ALBERT MARTIN TRAIL
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:TX
Practice Address - Zip Code:78629
Practice Address - Country:US
Practice Address - Phone:830-672-8502
Practice Address - Fax:830-672-3035
Is Sole Proprietor?:No
Enumeration Date:2010-07-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA06814363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant