Provider Demographics
NPI:1043328834
Name:WRIGHT, KENNETH EARL (PAC)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:EARL
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2967 OAK RUN PKWY # 210
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78132-5454
Mailing Address - Country:US
Mailing Address - Phone:830-626-5551
Mailing Address - Fax:
Practice Address - Street 1:2967 OAK RUN PKWY # 210
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78132-5454
Practice Address - Country:US
Practice Address - Phone:830-626-5551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA15893363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P34327Medicare UPIN