Healthcare Provider Details

I. General information

NPI: 1306296496
Provider Name (Legal Business Name): PRESTON WRIGHT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2016
Last Update Date: 08/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 N KANSAS ST
WICHITA KS
67214-3124
US

IV. Provider business mailing address

401 ALCORN DR STE 2C
CORINTH MS
38834-9073
US

V. Phone/Fax

Practice location:
  • Phone: 316-293-2665
  • Fax:
Mailing address:
  • Phone: 662-293-7618
  • Fax: 662-293-4358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number26861
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number94-08880
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: