Provider Demographics
NPI:1497716476
Name:WRIGHT, STACEY KAY (NP)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:KAY
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3810 E HARDESTY ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83716-5595
Mailing Address - Country:US
Mailing Address - Phone:208-631-0685
Mailing Address - Fax:208-322-5379
Practice Address - Street 1:5593 N GLENWOOD ST
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:ID
Practice Address - Zip Code:83714
Practice Address - Country:US
Practice Address - Phone:208-322-5354
Practice Address - Fax:208-322-5379
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV813271363LF0000X
IDNP539A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806663602Medicaid
ID806663602Medicaid
NVMW5044792OtherNEVADA DEA