Provider Demographics
NPI:1902549249
Name:WRIGHT, CASSIDY ELAINE
Entity Type:Individual
Prefix:MRS
First Name:CASSIDY
Middle Name:ELAINE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:CASSIDY
Other - Middle Name:ELAINE
Other - Last Name:HENDRIX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1821 JOHNSONS GROVE RD
Mailing Address - Street 2:
Mailing Address - City:BELLS
Mailing Address - State:TN
Mailing Address - Zip Code:38006-2229
Mailing Address - Country:US
Mailing Address - Phone:731-780-9962
Mailing Address - Fax:
Practice Address - Street 1:569 SKYLINE DR STE 101
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3911
Practice Address - Country:US
Practice Address - Phone:731-664-7395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-14
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program