Provider Demographics
NPI:1265662050
Name:MARTIN, ERICA EDITH (APN-BC)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:EDITH
Last Name:MARTIN
Suffix:
Gender:F
Credentials:APN-BC
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:STUCKEY
Other - Last Name:CULPEPPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1035 BELLEVUE AVE
Mailing Address - Street 2:SUITE 502
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1854
Mailing Address - Country:US
Mailing Address - Phone:314-638-3600
Mailing Address - Fax:314-638-4443
Practice Address - Street 1:1035 BELLEVUE AVE
Practice Address - Street 2:SUITE 502
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1854
Practice Address - Country:US
Practice Address - Phone:314-638-3600
Practice Address - Fax:314-638-4443
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO129669363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO129669OtherSTATE BD OF NURSING LICENSE