Healthcare Provider Details

I. General information

NPI: 1013406834
Provider Name (Legal Business Name): ASHLEY K WRIGHT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2018
Last Update Date: 12/09/2022
Certification Date: 12/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 SMITH ST
ORANGE PARK FL
32073-5554
US

IV. Provider business mailing address

PO BOX 746638
ATLANTA GA
30374-6638
US

V. Phone/Fax

Practice location:
  • Phone: 904-269-2140
  • Fax: 904-364-3018
Mailing address:
  • Phone: 904-202-1032
  • Fax: 904-376-3707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME151630
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: