Provider Demographics
NPI:1508073834
Name:ENRIGHT, MICHAEL (PHD, APRN)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:ENRIGHT
Suffix:
Gender:M
Credentials:PHD, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4120
Mailing Address - Street 2:557 EAST BROADWAY
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83001-4120
Mailing Address - Country:US
Mailing Address - Phone:307-733-7771
Mailing Address - Fax:307-733-8276
Practice Address - Street 1:557 EAST BROADWAY STREET
Practice Address - Street 2:MEDICAL ARTS BUILDING
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001-4120
Practice Address - Country:US
Practice Address - Phone:307-733-7771
Practice Address - Fax:307-733-8276
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY121103TC0700X
WY364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health