=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477207280
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | COLYN WRIGHT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/10/2022
-----------------------------------------------------
Last Update Date | 04/04/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 216 W WALNUT ST STE A
-----------------------------------------------------
City | DANVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40422-1858
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-236-5870
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 990
-----------------------------------------------------
City | DANVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40423-0990
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA3134
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------