Provider Demographics
NPI:1821243718
Name:WILSON, ERIN LEIGH (ARNP)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:LEIGH
Last Name:WILSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 S LIMESTONE
Mailing Address - Street 2:KENTUCKY CLINIC
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0001
Mailing Address - Country:US
Mailing Address - Phone:859-257-5536
Mailing Address - Fax:859-257-1888
Practice Address - Street 1:740 S LIMESTONE
Practice Address - Street 2:KENTUCKY CLINIC
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0001
Practice Address - Country:US
Practice Address - Phone:859-257-5536
Practice Address - Fax:859-257-1888
Is Sole Proprietor?:No
Enumeration Date:2008-11-19
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3005815363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100060600Medicaid
KY7100060600Medicaid
KY0912255Medicare PIN