Healthcare Provider Details

I. General information

NPI: 1205351830
Provider Name (Legal Business Name): JESSICA ANN WRIGHT NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2017
Last Update Date: 08/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5066 N 900 E
MONTGOMERY IN
47558-5790
US

IV. Provider business mailing address

2029 N 75 E
WASHINGTON IN
47501-7626
US

V. Phone/Fax

Practice location:
  • Phone: 812-486-3396
  • Fax:
Mailing address:
  • Phone: 812-486-6639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number28160792A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: