Provider Demographics
NPI:1043443062
Name:WRIGHT, ANGELA RENEE (ARNP-CNP)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:RENEE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:ARNP-CNP
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:RENEE
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP-C
Mailing Address - Street 1:702 BRYAN DR STE 100
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-7031
Mailing Address - Country:US
Mailing Address - Phone:580-924-4704
Mailing Address - Fax:580-924-6001
Practice Address - Street 1:702 BRYAN DR STE 100
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-7031
Practice Address - Country:US
Practice Address - Phone:580-924-4704
Practice Address - Fax:580-924-6001
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-25
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0082743163W00000X
TX735995163WE0003X, 390200000X
TXAP118767363LF0000X
OK82743363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB119566OtherMEDICARE PTAN