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Individual
KELLY L WRIGHT
Active
Individual
KELLY L WRIGHT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C, ATC
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
NULL
363A00000X
Physician Assistant
50-002191
OH
363AM0700X
Medical Physician Assistant
—
NULL
363AM0700X
Medical Physician Assistant
—
OH
363AS0400X
Surgical Physician Assistant
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000360053
ANTHEM
OH
05
—
1710959317
—
OH
Enumeration date
02/07/2006
Last updated
05/29/2021
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