Individual
MRS. ERICA C GREENWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1107 CROWN POINTE DR STE 107, ELIZABETHTOWN, KY 42701-7280
(270) 506-3300
(270) 506-2843
Mailing address
PO BOX 21890, BELFAST, ME 04915-4115
(502) 907-0356
(502) 919-9780
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA874
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11359005
CAQH ID
—
05
—
7100150780
—
KY
01
—
P01241187
MEDICARE RR
KY
Enumeration date
07/09/2008
Last updated
06/09/2022
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