Provider Demographics
NPI:1699973255
Name:WRIGHT, KELLY AUSTIN
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:AUSTIN
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3015 PROPHET DR
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NC
Mailing Address - Zip Code:27278-7820
Mailing Address - Country:US
Mailing Address - Phone:386-679-8699
Mailing Address - Fax:
Practice Address - Street 1:3015 PROPHET DR
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278-7820
Practice Address - Country:US
Practice Address - Phone:386-679-8699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARHM839022471C3402X, 2471M2300X
FLCRT604832471C3402X
VA01200038032471C3402X
MDR00070482471C3402X
SC0068612471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography
Not Answered2471M2300XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMammography