Provider Demographics
NPI:1053777953
Name:WRIGHT, MARY K (BA)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:K
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2698 CONIFER DR
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34951-2940
Mailing Address - Country:US
Mailing Address - Phone:772-579-0285
Mailing Address - Fax:772-492-9846
Practice Address - Street 1:2698 CONIFER DR
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34951-2940
Practice Address - Country:US
Practice Address - Phone:772-579-0285
Practice Address - Fax:772-492-9846
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-07
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator