Provider Demographics
NPI:1043394752
Name:LEATHERS, ERICA DAWN (FNPC)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:DAWN
Last Name:LEATHERS
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:DAWN
Other - Last Name:MANNING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1901 MEDI PARK DR STE 65
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-2105
Mailing Address - Country:US
Mailing Address - Phone:806-468-4333
Mailing Address - Fax:806-468-4334
Practice Address - Street 1:1901 MEDI PARK DR STE 65
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-2105
Practice Address - Country:US
Practice Address - Phone:806-468-4333
Practice Address - Fax:806-468-4334
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX658192363LF0000X
TXAP112821363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX416139ZHHLMedicare PIN
TX170606101Medicaid
TX1706061-06Medicaid