Provider Demographics
NPI:1528581444
Name:MARTIN, ERIN NICOLE
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:NICOLE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110 VILLAGE PKWY
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-2327
Mailing Address - Country:US
Mailing Address - Phone:859-887-8400
Mailing Address - Fax:859-885-8448
Practice Address - Street 1:110 VILLAGE PKWY
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-2327
Practice Address - Country:US
Practice Address - Phone:859-887-8400
Practice Address - Fax:859-885-8448
Is Sole Proprietor?:No
Enumeration Date:2017-07-23
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA2281363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant