Provider Demographics
NPI:1174965693
Name:WRIGHT, KENNETH L
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:L
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116 W 26TH ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209-4002
Mailing Address - Country:US
Mailing Address - Phone:904-781-7797
Mailing Address - Fax:904-781-8682
Practice Address - Street 1:1116 W 26TH ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-4002
Practice Address - Country:US
Practice Address - Phone:904-781-7797
Practice Address - Fax:904-781-8682
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker