Provider Demographics
NPI:1649576455
Name:FARKAS, ERIN ELAINE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:ELAINE
Last Name:FARKAS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:ERIN
Other - Middle Name:ELAINE
Other - Last Name:WILLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:545 DARE DR
Mailing Address - Street 2:
Mailing Address - City:MT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-9341
Mailing Address - Country:US
Mailing Address - Phone:859-274-3586
Mailing Address - Fax:
Practice Address - Street 1:401 COMMERCE CIR
Practice Address - Street 2:
Practice Address - City:MT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-7815
Practice Address - Country:US
Practice Address - Phone:859-498-5243
Practice Address - Fax:859-498-5396
Is Sole Proprietor?:No
Enumeration Date:2011-01-27
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006588363LP0200X
MDAC001365363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3006588OtherKY APRN
MDAC001365OtherMARYLAND APRN LINCESE
KY7100152740Medicaid