Basic Information
| Provider Information | |||||||||
| NPI: | 1073560371 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WRIGHT | ||||||||
| FirstName: | GWENDYLON | ||||||||
| MiddleName: | F. | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 90039 | ||||||||
| Address2: | |||||||||
| City: | BOWLING GREEN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 421029039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707835338 | ||||||||
| FaxNumber: | 2707969328 | ||||||||
| Practice Location | |||||||||
| Address1: | 427 US 31W BYP | ||||||||
| Address2: | |||||||||
| City: | BOWLING GREEN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 421011703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707968000 | ||||||||
| FaxNumber: | 2707969328 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2006 | ||||||||
| LastUpdateDate: | 09/22/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 16209 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 3001620 | 01 | KY | APRN LICENSE | OTHER | 78016201 | 05 | KY | MEDICAID |