Provider Demographics
NPI:1407031560
Name:ERLICHSON, KATHY L (APRN BC)
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:L
Last Name:ERLICHSON
Suffix:
Gender:F
Credentials:APRN BC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:12680 OLIVE BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6322
Mailing Address - Country:US
Mailing Address - Phone:314-251-8892
Mailing Address - Fax:
Practice Address - Street 1:12680 OLIVE BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141
Practice Address - Country:US
Practice Address - Phone:314-251-8892
Practice Address - Fax:314-251-8894
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO074643363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO152800020Medicare PIN