Provider Demographics
NPI:1891247748
Name:WRIGHT, MANDY MARIE (AGACNP)
Entity Type:Individual
Prefix:MRS
First Name:MANDY
Middle Name:MARIE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:MANDY
Other - Middle Name:MARIE
Other - Last Name:FULLINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:520 MARY ST
Mailing Address - Street 2:STE 520
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710-1682
Mailing Address - Country:US
Mailing Address - Phone:812-424-8231
Mailing Address - Fax:812-435-8794
Practice Address - Street 1:520 MARY ST STE 520
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1682
Practice Address - Country:US
Practice Address - Phone:812-424-8231
Practice Address - Fax:812-435-8794
Is Sole Proprietor?:No
Enumeration Date:2016-10-26
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71006822A363LG0600X, 363LG0600X
INXXXXXXXXX363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000001070519OtherANTHEM BCBS
IN300002641Medicaid
IN71006822OtherINDIANA STATE LICENSE
KY7100465900Medicaid
KY7100465900Medicaid