Provider Demographics
NPI:1144750951
Name:BRIGHT, ERICA
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:BRIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 MADISON CIR
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-8178
Mailing Address - Country:US
Mailing Address - Phone:606-261-5845
Mailing Address - Fax:
Practice Address - Street 1:204 TOWN BRANCH RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40962-1322
Practice Address - Country:US
Practice Address - Phone:606-598-8766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY474730776OtherTAX ID