MEDICARE: ALYSHA ERVIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1902228117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSHA ERVIN

Provider Business Mailing Address
First Line	:	112 SARTIN DR
Second Line	:
City	:	EDMONTON
State	:	KY
Zip	:	42129-8170
Country	:	US
Telephone Number	:	270-432-4951
Fax Number	:	270-432-5054

Provider Business Practice Location Address
First Line	:	112 SARTIN DR
Second Line	:
City	:	EDMONTON
State	:	KY
Zip	:	42129-8170
Country	:	US
Telephone Number	:	270-432-4951
Fax Number	:	270-432-5054

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2014
Last Update Date	:	01/08/2014

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Directions to “ ALYSHA ERVIN ” Practice Location

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