Provider Demographics
NPI:1235659004
Name:STICKELS, ERIN DAWN (PA-C)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:DAWN
Last Name:STICKELS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:ERIN
Other - Middle Name:DAWN
Other - Last Name:STICKELS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:6534 WATSON LN
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-4387
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1606 23RD AVE
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-6407
Practice Address - Country:US
Practice Address - Phone:907-455-4567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-22
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK123458363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant