Provider Demographics
NPI:1093441057
Name:ERICKSON, IAN
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:
Last Name:ERICKSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4911 BRIDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-5657
Mailing Address - Country:US
Mailing Address - Phone:910-644-2017
Mailing Address - Fax:
Practice Address - Street 1:300 W CENTRAL TEXAS EXPY STE 115
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-1888
Practice Address - Country:US
Practice Address - Phone:254-833-9162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-01
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant