MEDICARE: ERIN OLIVIA MANUEL APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	4058903	KY

General Provider Information

NPI Number	:	1679404354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN OLIVIA MANUEL APRN

Provider Business Mailing Address
First Line	:	173 BANYAN BLVD
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-8370
Country	:	US
Telephone Number	:	859-948-8862
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 MOORE DR STE 205
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40503-2951
Country	:	US
Telephone Number	:	859-489-4126
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2026
Last Update Date	:	05/29/2026

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