Provider Demographics
NPI:1225703374
Name:CHRONISTER, ERRICA LEIGH (RN)
Entity Type:Individual
Prefix:MRS
First Name:ERRICA
Middle Name:LEIGH
Last Name:CHRONISTER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:ERRICA
Other - Middle Name:LEIGH
Other - Last Name:CHRONISTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:106927 S 4806 RD
Mailing Address - Street 2:
Mailing Address - City:MULDROW
Mailing Address - State:OK
Mailing Address - Zip Code:74948-7648
Mailing Address - Country:US
Mailing Address - Phone:479-806-9456
Mailing Address - Fax:
Practice Address - Street 1:1001 TOWSON AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-4921
Practice Address - Country:US
Practice Address - Phone:479-441-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0130188163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKR0130188OtherLICENSE NUMBER