Basic Information
| Provider Information | |||||||||
| NPI: | 1295070571 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAZZELL | ||||||||
| FirstName: | ERICA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 S 8TH ST | ||||||||
| Address2: | SUITE 480W | ||||||||
| City: | MURRAY | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420712400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707621515 | ||||||||
| FaxNumber: | 2707522852 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 S 8TH ST | ||||||||
| Address2: | SUITE 480W | ||||||||
| City: | MURRAY | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420712400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707621515 | ||||||||
| FaxNumber: | 2707522852 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2012 | ||||||||
| LastUpdateDate: | 04/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 3007670 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.