Provider Demographics
NPI:1295070571
Name:BAZZELL, ERICA A (APRN)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:A
Last Name:BAZZELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S 8TH ST
Mailing Address - Street 2:SUITE 480W
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-2400
Mailing Address - Country:US
Mailing Address - Phone:270-762-1515
Mailing Address - Fax:270-752-2852
Practice Address - Street 1:300 S 8TH ST STE 380W
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-2442
Practice Address - Country:US
Practice Address - Phone:270-753-0704
Practice Address - Fax:270-752-2852
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-28
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007670363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner