Healthcare Provider Details

I. General information

NPI: 1316466402
Provider Name (Legal Business Name): ERIKA PAIGE FORD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2017
Last Update Date: 02/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 KRESGE WAY STE 303
LOUISVILLE KY
40207-4637
US

IV. Provider business mailing address

2700 STANLEY GAULT PKWY STE 129
LOUISVILLE KY
40223-5176
US

V. Phone/Fax

Practice location:
  • Phone: 502-928-5000
  • Fax: 502-928-5001
Mailing address:
  • Phone: 505-253-4900
  • Fax: 502-489-5751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2270
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: