Healthcare Provider Details

I. General information

NPI: 1346403326
Provider Name (Legal Business Name): ERICA C GREENWELL PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 CHAMBERS BLVD
BARDSTOWN KY
40004-2575
US

IV. Provider business mailing address

PO BOX 21890
BELFAST ME
04915-4115
US

V. Phone/Fax

Practice location:
  • Phone: 270-506-3300
  • Fax: 270-506-2843
Mailing address:
  • Phone: 502-907-0356
  • Fax: 502-919-9780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA874
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: