Provider Demographics
NPI:1588370647
Name:WRIGHT, KELLY DANEEN (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:DANEEN
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1515
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74702-1515
Mailing Address - Country:US
Mailing Address - Phone:661-249-6625
Mailing Address - Fax:
Practice Address - Street 1:1 SAINT VINCENT CIR STE 120
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5406
Practice Address - Country:US
Practice Address - Phone:501-552-2660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR223096363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily