Provider Demographics
NPI:1811090848
Name:WRIGHT, CHARLES KENT (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:KENT
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:C.
Other - Middle Name:KENT
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:P.O. BOX 130
Mailing Address - Street 2:
Mailing Address - City:RATCLIFF
Mailing Address - State:AR
Mailing Address - Zip Code:72951
Mailing Address - Country:US
Mailing Address - Phone:479-635-5700
Mailing Address - Fax:479-635-2010
Practice Address - Street 1:1901 BOSTON ST.
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901
Practice Address - Country:US
Practice Address - Phone:479-782-0075
Practice Address - Fax:479-782-0090
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC7768207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR122295001Medicaid
AR122295001Medicaid
E54723Medicare UPIN