MEDICARE: MS. ERIN WILDER CHISWELL 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	163W00000X	Registered Nurse	1091753	KY
2	363LF0000X	Family Nurse Practitioner	3004938	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790871218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ERIN WILDER CHISWELL APRN

Provider Business Mailing Address
First Line	:	4600 MONTGOMERY RD STE 400
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45212-2600
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	245 FOUNTAIN CT STE 120
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-2792
Country	:	US
Telephone Number	:	859-218-2626
Fax Number	:	859-257-3322

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	09/24/2025

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