Healthcare Provider Details

I. General information

NPI: 1255030516
Provider Name (Legal Business Name): ERIN PAIGE GREENLEE PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIN PAIGE ROSS RN

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 DARBY CREEK RD UNIT C
LEXINGTON KY
40509-1603
US

IV. Provider business mailing address

5300 STEWART RD
LEXINGTON KY
40516-9519
US

V. Phone/Fax

Practice location:
  • Phone: 859-368-2567
  • Fax: 859-788-3905
Mailing address:
  • Phone: 740-505-4242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1140495
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4010911
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: