Healthcare Provider Details

I. General information

NPI: 1497458665
Provider Name (Legal Business Name): ERICA CREECH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2023
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 THOMAS MORE PKWY STE 202
EDGEWOOD KY
41017-5103
US

IV. Provider business mailing address

2123 AUBURN AVE STE 404
CINCINNATI OH
45219-2906
US

V. Phone/Fax

Practice location:
  • Phone: 859-341-6281
  • Fax: 859-341-4661
Mailing address:
  • Phone: 513-241-5630
  • Fax: 513-241-7146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number4006496
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1161341
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: