Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 04-15171 | KS |
NPI | 1003838335 |
---|---|
Provider Name | Kendall Merritt Wright |
First Address | Emporia, KS 66801-2504 |
Second Address | Emporia, KS 66801-2587 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 02/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100207160C | (05) | KS |
103207 | BC/BS (01) | KS |
B69378 | (02) | KS |
P00057491 | MEDICARE RAILROAD (01) | KS |