Provider Demographics
NPI:1235485665
Name:WOOLDRIDGE, ERIKA JEAN MARIE (APRN)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:JEAN MARIE
Last Name:WOOLDRIDGE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 E LIBERTY ST
Mailing Address - Street 2:SUITE 800
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1434
Mailing Address - Country:US
Mailing Address - Phone:502-543-4119
Mailing Address - Fax:502-543-1462
Practice Address - Street 1:187 ADAM SHEPHERD PKWY
Practice Address - Street 2:SUITE 5
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-7500
Practice Address - Country:US
Practice Address - Phone:502-543-4119
Practice Address - Fax:502-543-1462
Is Sole Proprietor?:No
Enumeration Date:2012-08-03
Last Update Date:2018-03-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY3007547363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100310500Medicaid
KYP01407697 (KOHMG) RRMedicare PIN
KYK065041Medicare PIN