Provider Demographics
NPI:1588792071
Name:WRIGHT, TRACY ANN (PA-C)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:ANN
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:PA-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 A
Mailing Address - Street 2:
Mailing Address - City:CRESSON
Mailing Address - State:PA
Mailing Address - Zip Code:16699-0001
Mailing Address - Country:US
Mailing Address - Phone:814-886-4266
Mailing Address - Fax:814-886-8573
Practice Address - Street 1:251 CORRECTIONS ROAD
Practice Address - Street 2:
Practice Address - City:CRESSON
Practice Address - State:PA
Practice Address - Zip Code:16699-0001
Practice Address - Country:US
Practice Address - Phone:814-886-4266
Practice Address - Fax:814-886-8573
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-24
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2007-07-24
Provider Licenses
StateLicense IDTaxonomies
PAMA-002478L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant