Basic Information
| Provider Information | |||||||||
| NPI: | 1750352712 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WRIGHT | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1020 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | BEAVER DAM | ||||||||
| State: | KY | ||||||||
| PostalCode: | 423201553 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2702740480 | ||||||||
| FaxNumber: | 2702740482 | ||||||||
| Practice Location | |||||||||
| Address1: | 1211 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | HARTFORD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 423471619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2702987411 | ||||||||
| FaxNumber: | 2702740482 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2006 | ||||||||
| LastUpdateDate: | 08/28/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 1027758 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 000000051230 | 01 | KY | ANTHEM BCBS PIN | OTHER | 430052321 | 01 | KY | RAILROAD MEDICARE PIN | OTHER | 200213590B | 05 | IN | MEDICAID | 74239310 | 05 | KY | MEDICAID | 200213590C | 05 | IN | MEDICAID |