Basic Information
| Provider Information | |||||||||
| NPI: | 1558466102 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WRIGHT | ||||||||
| FirstName: | JILL | ||||||||
| MiddleName: | CATHERINE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5613 CALTON DRIVE | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194200236 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2620 NEW BERN AVENUE | ||||||||
| Address2: | NEW BERN RIDGE PEDIATRICS | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192313180 | ||||||||
| FaxNumber: | 9192318077 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2006 | ||||||||
| LastUpdateDate: | 08/21/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 9701664 | NC | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 891105C | 05 | NC | MEDICAID | 1782871 | 01 | NC | UNITED HEALTH CARE | OTHER | 1105C | 01 | NC | BLUE CROSS BLUE SHIELD | OTHER | 218891 | 01 | NC | WELL PATH | OTHER | 5356993 | 01 | NC | CIGNA | OTHER |