Provider Demographics
NPI:1194128462
Name:WRIGHT, ELIZABETH IVY (APRN)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:IVY
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:IVY
Other - Last Name:DEESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:5661 US HIGHWAY 62 W
Mailing Address - Street 2:
Mailing Address - City:CYNTHIANA
Mailing Address - State:KY
Mailing Address - Zip Code:41031-8046
Mailing Address - Country:US
Mailing Address - Phone:859-492-2191
Mailing Address - Fax:
Practice Address - Street 1:3576 PIMLICO PKWY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-3700
Practice Address - Country:US
Practice Address - Phone:859-272-0608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-01
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3008993363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
12750267OtherCAQH
KY7100331380Medicaid