Healthcare Provider Details

I. General information

NPI: 1497446009
Provider Name (Legal Business Name): ERIN MCDANIEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2023
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4645 VILLAGE SQUARE DR STE A
PADUCAH KY
42001-7448
US

IV. Provider business mailing address

4645 VILLAGE SQUARE DR STE A
PADUCAH KY
42001-7448
US

V. Phone/Fax

Practice location:
  • Phone: 270-391-2396
  • Fax:
Mailing address:
  • Phone: 270-391-2396
  • Fax: 270-391-2398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number24-325307
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: