Provider Demographics
NPI:1033509393
Name:GARRETT -WRIGHT, DAWN
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:GARRETT -WRIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:MARIE
Other - Last Name:GARRETT WRIGHT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMHNP
Mailing Address - Street 1:1322 FLEENOR WAY
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-4330
Mailing Address - Country:US
Mailing Address - Phone:270-320-1174
Mailing Address - Fax:
Practice Address - Street 1:350 PARK STREET STE 204
Practice Address - Street 2:PSYCHIATRIC ASSOCIATES
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-3516
Practice Address - Country:US
Practice Address - Phone:270-843-5103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-26
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3009019363LP0808X
KY1089439163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health