Provider Demographics
NPI:1962513317
Name:WRIGHT, TERESA MAY (NP)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:MAY
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1912 PENILE RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY STATION
Mailing Address - State:KY
Mailing Address - Zip Code:40272-2120
Mailing Address - Country:US
Mailing Address - Phone:502-836-6573
Mailing Address - Fax:
Practice Address - Street 1:1912 PENILE RD
Practice Address - Street 2:
Practice Address - City:VALLEY STATION
Practice Address - State:KY
Practice Address - Zip Code:40272
Practice Address - Country:US
Practice Address - Phone:502-836-6573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2019-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71004406A363LA2200X
KY3004435363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78013455000Medicaid
0623648Medicare PIN