Provider Demographics
NPI:1225770308
Name:BALES, ERICA LEIGHANN (FNP-C)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:LEIGHANN
Last Name:BALES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5625 LONE STAR RD
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-7950
Mailing Address - Country:US
Mailing Address - Phone:423-817-5418
Mailing Address - Fax:
Practice Address - Street 1:5625 LONE STAR RD
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-7950
Practice Address - Country:US
Practice Address - Phone:423-817-5418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-10
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4011026363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily