Provider Demographics
NPI:1831441823
Name:AZBELL, ERIN BOUDREAUX (APRN)
Entity type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:BOUDREAUX
Last Name:AZBELL
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 1:4821 PLEASANT GROVE RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-1601
Mailing Address - Country:US
Mailing Address - Phone:052-873-0855
Mailing Address - Fax:
Practice Address - Street 1:1517 NICHOLASVILLE RD STE 405
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1429
Practice Address - Country:US
Practice Address - Phone:859-278-8469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-15
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007638363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100223490Medicaid
KY000000887724OtherANTHEM-NMA
KY164897OtherSIHO
KY50074386OtherPASSPORT-NMA
KY50074386OtherPASSPORT-NMA