Healthcare Provider Details

I. General information

NPI: 1518519651
Provider Name (Legal Business Name): ERIKA SPARKS BLAIR APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2019
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 WOODLAND DR STE B100
ELIZABETHTOWN KY
42701-2709
US

IV. Provider business mailing address

1205 WOODLAND DR STE B100
ELIZABETHTOWN KY
42701-2709
US

V. Phone/Fax

Practice location:
  • Phone: 270-359-5524
  • Fax: 270-359-5566
Mailing address:
  • Phone: 270-359-5524
  • Fax: 270-359-5566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3013603
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: