Individual
KEVIN RANDALL WRIGHT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
085002508
IL
363AS0400X
Surgical Physician Assistant
Primary
085002508
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
085002508
—
IL
01
—
P00297120
RAILROAD MEDICARE
IL
Enumeration date
09/27/2005
Last updated
03/26/2026
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