Provider Demographics
NPI:1093140030
Name:ATKINSON, ERIC LOYAL (PA-C)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:LOYAL
Last Name:ATKINSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 E PRIMROSE ST STE D
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-7910
Mailing Address - Country:US
Mailing Address - Phone:417-882-1818
Mailing Address - Fax:417-882-1821
Practice Address - Street 1:1530 E PRIMROSE ST STE D
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-7910
Practice Address - Country:US
Practice Address - Phone:417-882-1818
Practice Address - Fax:417-882-1821
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018031270363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant