Individual provider Active NPI

Timothy J. Wright, FNP

  • Nurse Practitioner
  • Fresno, CA
National Provider Identifier
1164512240
Registry record updated May 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
95013299 Issued in CA
Practice address
3580 E California Ave BLDG B
Fresno, CA 93702-4211
Phone
(559) 263-7555
Fax
(559) 263-5719
NPI assigned
Oct 13, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 13, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse First Assistant 163WR0006X 519484 CA
Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363L00000X 95013299 CA Primary

Addresses

Primary practice location

3580 E California Ave BLDG B
Fresno, CA 93702-4211

Mailing address

3580 E California Ave BLDG B
Fresno, CA 93702-4211
Phone (592) 637-5555

Other practice location 1

2609 16th Ave
Kingsburg, CA 93631-1116
Phone (559) 305-3209

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200302001944 CA Practitioner - Nurse Practitioner 4587091665 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
519484CAMDRegistered Nurse First Assistant
95013299CAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Agnes Medical Foundation Single Specialty CurrentSince Feb 1, 2021 Accepting new patients
LQMG Medical Group Inc. Single Specialty Current Accepting new patients
Advanced Care Medical Group Inc Single Specialty CurrentSince Mar 30, 2021 Accepting new patients

Locations

1510 E Herndon Ave
Ste 110
Fresno, CA 93720
Phone (559) 450-6742

1221 E Spruce Ave
Fresno, CA 93720
Phone (559) 449-5777

3130 W Caldwell Ave
Visalia, CA 93277
Phone (559) 635-7800

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715558400000",
    "number": "1164512240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3580 E CALIFORNIA AVE BLDG B",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937024211",
            "telephone_number": "592-637-5555",
            "fax_number": "559-263-5719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3580 E CALIFORNIA AVE BLDG B",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937024211",
            "telephone_number": "559-263-7555",
            "fax_number": "559-263-5719"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2609 16th Ave",
            "address_purpose": "LOCATION",
            "city": "Kingsburg",
            "state": "CA",
            "postal_code": "936311116",
            "country_code": "US",
            "telephone_number": "559-305-3209",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WRIGHT",
        "first_name": "TIMOTHY",
        "middle_name": "J.",
        "name_prefix": "Mr.",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-13",
        "last_updated": "2024-05-13",
        "certification_date": "2022-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WR0006X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Registered Nurse First Assistant",
            "state": "CA",
            "license": "519484",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "95013299",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fresno, CA

Sources for this page

Verify at the official NPI Registry.