Provider Demographics
NPI:1215537659
Name:ANDERSON, ERICA LEONNA (CPNP-PC)
Entity Type:Individual
Prefix:MS
First Name:ERICA
Middle Name:LEONNA
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 LEXINGTON DR STE A
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-6986
Mailing Address - Country:US
Mailing Address - Phone:601-707-3771
Mailing Address - Fax:
Practice Address - Street 1:101 LEXINGTON DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-6985
Practice Address - Country:US
Practice Address - Phone:601-707-3771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-26
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903975363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics