Provider Demographics
NPI:1497165401
Name:WINSTEAD, ERIC
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:WINSTEAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12410 HEDGEAPPLE WAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40272-4477
Mailing Address - Country:US
Mailing Address - Phone:502-599-3331
Mailing Address - Fax:
Practice Address - Street 1:12410 HEDGEAPPLE WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40272-4477
Practice Address - Country:US
Practice Address - Phone:502-599-3331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-29
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2050078164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse