MEDICARE: MRS. JESSIELENE WRIGHT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	4009489	KY

General Provider Information

NPI Number	:	1497521710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSIELENE WRIGHT

Provider Business Mailing Address
First Line	:	486 LINE CREEK RD
Second Line	:
City	:	LILY
State	:	KY
Zip	:	40740-2928
Country	:	US
Telephone Number	:	606-309-7681
Fax Number	:

Provider Business Practice Location Address
First Line	:	2700 OLD ROSEBUD RD STE 350
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-8630
Country	:	US
Telephone Number	:	859-523-1776
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2023
Last Update Date	:	11/28/2023

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