Basic Information
Provider Information
NPI: 1457842403
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WRIGHT
FirstName: KAY-ANN
MiddleName:  
NamePrefix: MS.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1989 PASS RD
Address2:  
City: BILOXI
State: MS
PostalCode: 395314103
CountryCode: US
TelephoneNumber: 2282071248
FaxNumber: 2283886182
Practice Location
Address1: 1989 PASS RD
Address2:  
City: BILOXI
State: MS
PostalCode: 395314103
CountryCode: US
TelephoneNumber: 2282071248
FaxNumber: 2283886418
Other Information
ProviderEnumerationDate: 05/25/2018
LastUpdateDate: 05/25/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YA0400X  Y Behavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)

No ID Information.


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