MEDICARE: MR. VERNON ALVIN WRIGHT PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA2905	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235169665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. VERNON ALVIN WRIGHT PA-C

Provider Business Mailing Address
First Line	:	2402 FRIST BLVD STE 204
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-4838
Country	:	US
Telephone Number	:	772-466-1113
Fax Number	:	772-466-1103

Provider Business Practice Location Address
First Line	:	2402 FRIST BLVD STE 204
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-4838
Country	:	US
Telephone Number	:	772-466-1113
Fax Number	:	772-466-1103

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	02/01/2022

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