Provider Demographics
NPI:1386787679
Name:WRIGHT, ROBBIN ALEXANDER (BOCP)
Entity type:Individual
Prefix:MRS
First Name:ROBBIN
Middle Name:ALEXANDER
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:BOCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 HIGHWAY 49
Mailing Address - Street 2:SUITE Q
Mailing Address - City:FLORA
Mailing Address - State:MS
Mailing Address - Zip Code:39071-9278
Mailing Address - Country:US
Mailing Address - Phone:601-401-5095
Mailing Address - Fax:601-401-5096
Practice Address - Street 1:740 HIGHWAY 49
Practice Address - Street 2:SUITE Q
Practice Address - City:FLORA
Practice Address - State:MS
Practice Address - Zip Code:39071-9278
Practice Address - Country:US
Practice Address - Phone:601-401-5095
Practice Address - Fax:601-401-5096
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2017-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS000440915Medicaid
MS000440915Medicaid