Provider Demographics
NPI:1912235052
Name:POWELL, ERICKA LYNSEY
Entity type:Individual
Prefix:MISS
First Name:ERICKA
Middle Name:LYNSEY
Last Name:POWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 GOLD CITY RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:KY
Mailing Address - Zip Code:42134-5166
Mailing Address - Country:US
Mailing Address - Phone:270-799-6055
Mailing Address - Fax:
Practice Address - Street 1:1906 COLLEGE HEIGHTS BLVD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1000
Practice Address - Country:US
Practice Address - Phone:270-745-4232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist