Healthcare Provider Details

I. General information

NPI: 1851986277
Provider Name (Legal Business Name): ERIN DEAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2021
Last Update Date: 11/08/2021
Certification Date: 11/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 PHILLIPS CT
HENDERSON KY
42420-4314
US

IV. Provider business mailing address

4 PHILLIPS CT
HENDERSON KY
42420
US

V. Phone/Fax

Practice location:
  • Phone: 270-399-6501
  • Fax:
Mailing address:
  • Phone: 270-399-6501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3016950
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1148794
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: