Provider Demographics
NPI:1750352712
Name:WRIGHT, ROBERT L (CRNA)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BEAVER DAM
Mailing Address - State:KY
Mailing Address - Zip Code:42320-1553
Mailing Address - Country:US
Mailing Address - Phone:270-274-0480
Mailing Address - Fax:270-274-0482
Practice Address - Street 1:1211 MAIN ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:KY
Practice Address - Zip Code:42347-1619
Practice Address - Country:US
Practice Address - Phone:270-298-7411
Practice Address - Fax:270-274-0482
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1027758367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000051230OtherANTHEM BCBS PIN
KY430052321OtherRAILROAD MEDICARE PIN
IN200213590BMedicaid
KY74239310Medicaid
IN200213590CMedicaid
KY0699601Medicare ID - Type Unspecified
KY74239310Medicaid
KY0572701Medicare ID - Type Unspecified