Provider Demographics
NPI:1679561617
Name:WRIGHT, AMY HERRET (CNP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:HERRET
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 S 18TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-2696
Mailing Address - Country:US
Mailing Address - Phone:614-722-4554
Mailing Address - Fax:614-722-4565
Practice Address - Street 1:555 S 18TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-2696
Practice Address - Country:US
Practice Address - Phone:614-722-4554
Practice Address - Fax:614-722-4565
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN267084363LP0200X
OHNP07068363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78012309Medicaid
OH2493850Medicaid
KY78012309Medicaid
OH2493850Medicaid