Provider Demographics
NPI:1417913120
Name:WRIGHT, PHYLLIS RENEE (FNP)
Entity Type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:RENEE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153A S MARKET ST
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:38635-3029
Mailing Address - Country:US
Mailing Address - Phone:662-252-9987
Mailing Address - Fax:662-252-7517
Practice Address - Street 1:153A S MARKET ST
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:38635-3029
Practice Address - Country:US
Practice Address - Phone:662-252-9987
Practice Address - Fax:662-252-7517
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR575399207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0121760Medicaid
MSMW0951485OtherDEA NUMBER
MSMW0951485OtherDEA NUMBER
MS500000651Medicare ID - Type Unspecified