Provider Demographics
NPI:1487389466
Name:WRIGHT, KIMBERLY ANN (APS)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:APS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 E 55TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44103-1304
Mailing Address - Country:US
Mailing Address - Phone:216-391-6672
Mailing Address - Fax:216-391-4633
Practice Address - Street 1:4642 OBERLIN AVE STE 102
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-3164
Practice Address - Country:US
Practice Address - Phone:440-282-1800
Practice Address - Fax:440-218-2519
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.003384175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty