1992347215 NPI number — KATHERINE M WRIGHT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992347215 NPI number — KATHERINE M WRIGHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WRIGHT
Provider First Name:
KATHERINE
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992347215
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
161 JD TOWLES DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLOW PARK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76087-8654
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
682-900-1444
Provider Business Mailing Address Fax Number:
682-900-1444

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12333 BEAR PLZ STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURLESON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76028-0215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
682-900-1444
Provider Business Practice Location Address Fax Number:
682-900-1444
Provider Enumeration Date:
10/09/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106S00000X , with the licence number:  RBT-18-72810 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103K00000X , with the licence number: 5064 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)