Provider Demographics
NPI:1710963913
Name:WRIGHT, JESSICA LYNN (ACNP-BC, AGACNP-BC)
Entity type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:LYNN
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:ACNP-BC, AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 BENFORD DR
Mailing Address - Street 2:
Mailing Address - City:BOILING SPRINGS
Mailing Address - State:SC
Mailing Address - Zip Code:29316-7735
Mailing Address - Country:US
Mailing Address - Phone:864-237-2696
Mailing Address - Fax:
Practice Address - Street 1:260 FAIRWINDS RD
Practice Address - Street 2:
Practice Address - City:LANDRUM
Practice Address - State:SC
Practice Address - Zip Code:29356-9075
Practice Address - Country:US
Practice Address - Phone:644-579-1008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC960064363LA2100X
SCAC3467363LA2100X
SC3467363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP1192Medicaid
SCP01402549OtherRAILROAD MEDICARE
NC7004101Medicaid
SCAA25673365Medicare PIN
SCNP1192Medicaid
SCP01402549OtherRAILROAD MEDICARE
SCAA25676655Medicare PIN
AA25675640Medicare PIN
SCAA25677628Medicare PIN