Healthcare Provider Details

I. General information

NPI: 1164512240
Provider Name (Legal Business Name): TIMOTHY J. WRIGHT FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 05/13/2024
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3580 E CALIFORNIA AVE BLDG B
FRESNO CA
93702-4211
US

IV. Provider business mailing address

3580 E CALIFORNIA AVE BLDG B
FRESNO CA
93702-4211
US

V. Phone/Fax

Practice location:
  • Phone: 559-263-7555
  • Fax: 559-263-5719
Mailing address:
  • Phone: 592-637-5555
  • Fax: 559-263-5719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number519484
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95013299
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: