Healthcare Provider Details

I. General information

NPI: 1487938809
Provider Name (Legal Business Name): TIFFANY NICOLE WRIGHT PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2011
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

253 HAGER BR
EAST POINT KY
41216-8766
US

IV. Provider business mailing address

253 HAGER BR
EAST POINT KY
41216-8766
US

V. Phone/Fax

Practice location:
  • Phone: 606-887-1005
  • Fax: 606-764-1813
Mailing address:
  • Phone: 606-887-1005
  • Fax: 606-764-1813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3007185
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number3007185
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: