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Individual
KENNETH DEAN WRIGHT
Active
Individual
KENNETH DEAN WRIGHT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
157
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001721578
BCBS MOUNTAIN STATE
WV
01
—
030028200
BLACK LUNG
WV
01
—
550357050
UNITED MINE WORKERS
WV
05
—
95690020
—
KY
Enumeration date
03/24/2006
Last updated
07/17/2013
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