Basic Information
| Provider Information | |||||||||
| NPI: | 1295971661 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WRIGHT | ||||||||
| FirstName: | DIANA | ||||||||
| MiddleName: | S. | ||||||||
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| Credential: | CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 90 JACKSON PIKE | ||||||||
| Address2: | |||||||||
| City: | GALLIPOLIS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456311560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403958805 | ||||||||
| FaxNumber: | 7403958855 | ||||||||
| Practice Location | |||||||||
| Address1: | 280 PATTONSVILLE RD | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456409452 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403958805 | ||||||||
| FaxNumber: | 7403958855 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2009 | ||||||||
| LastUpdateDate: | 01/11/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | APRN.CNP.10070 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 310917085205 | 01 | OH | OH MEDICAID CARESOURCE | OTHER | 3810014716 | 05 | WV | MEDICAID | 2953362 | 01 | OH | OH MEDICAID MOLINA | OTHER | 2953362 | 05 | OH | MEDICAID | 000000267588 | 01 | OH | OH MEDICAID UNISON | OTHER | PO0715355 | 01 | OH | MEDICARE RAILROAD | OTHER |