Provider Demographics
NPI:1053901934
Name:WRIGHT, STEPHEN D JR (FNP-BC)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:D
Last Name:WRIGHT
Suffix:JR
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4508 GRANDIN RD SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-1924
Mailing Address - Country:US
Mailing Address - Phone:540-312-5177
Mailing Address - Fax:
Practice Address - Street 1:8333 N DAVIS HWY FL 4
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-6050
Practice Address - Country:US
Practice Address - Phone:850-969-7979
Practice Address - Fax:850-476-9352
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-25
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024182489363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner