Provider Demographics
NPI:1437709060
Name:ERIKSSON, KATHRYN RENEE (FNP-C)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:RENEE
Last Name:ERIKSSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:RENEE
Other - Last Name:KLAAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 12
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0012
Mailing Address - Country:US
Mailing Address - Phone:406-541-7000
Mailing Address - Fax:
Practice Address - Street 1:2829 GREAT NORTHERN LOOP STE 300
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1752
Practice Address - Country:US
Practice Address - Phone:406-541-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-16
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT146738363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily