Healthcare Provider Details

I. General information

NPI: 1902549249
Provider Name (Legal Business Name): MRS. CASSIDY ELAINE WRIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS CASSIDY ELAINE HENDRIX

II. Dates (important events)

Enumeration Date: 04/14/2022
Last Update Date: 09/01/2022
Certification Date: 06/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

569 SKYLINE DR STE 101
JACKSON TN
38301-3911
US

IV. Provider business mailing address

1821 JOHNSONS GROVE RD
BELLS TN
38006-2229
US

V. Phone/Fax

Practice location:
  • Phone: 731-664-7395
  • Fax:
Mailing address:
  • Phone: 731-780-9962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: