Healthcare Provider Details

I. General information

NPI: 1003838335
Provider Name (Legal Business Name): KENDALL MERRITT WRIGHT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 04/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 W 12TH AVE SUITE 301
EMPORIA KS
66801-2587
US

IV. Provider business mailing address

1201 W 12TH AVE
EMPORIA KS
66801-2504
US

V. Phone/Fax

Practice location:
  • Phone: 620-343-2376
  • Fax: 620-343-0095
Mailing address:
  • Phone: 620-343-6800
  • Fax: 620-341-7821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number04-15171
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: