Basic Information
| Provider Information | |||||||||
| NPI: | 1609850106 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WRIGHT | ||||||||
| FirstName: | RONNA | ||||||||
| MiddleName: | KIM | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 607 | ||||||||
| Address2: | |||||||||
| City: | APPOMATTOX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245220607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4343528235 | ||||||||
| FaxNumber: | 4343525532 | ||||||||
| Practice Location | |||||||||
| Address1: | 131 JONES ST | ||||||||
| Address2: | |||||||||
| City: | APPOMATTOX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245229830 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4343528235 | ||||||||
| FaxNumber: | 4343525532 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2005 | ||||||||
| LastUpdateDate: | 08/13/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 0101045940 | VA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 005608848 | 05 | VA | MEDICAID | 080133235 | 01 | MEDICARE RAILROAD PROVIDER NUMBER | OTHER | 437477 | 01 | ANTHEM | OTHER |