Healthcare Provider Details

I. General information

NPI: 1922048503
Provider Name (Legal Business Name): ALAN STEVENS WRIGHTSON JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 04/03/2020
Certification Date: 04/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1306 VERSAILLES RD STE 120
LEXINGTON KY
40504-1796
US

IV. Provider business mailing address

1306 VERSAILLES RD STE 120
LEXINGTON KY
40504-1796
US

V. Phone/Fax

Practice location:
  • Phone: 859-259-0717
  • Fax: 859-254-7874
Mailing address:
  • Phone: 859-259-0717
  • Fax: 859-254-7874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25346
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: