Provider Demographics
NPI:1457672990
Name:RED CORN, ERICA JEAN (MD)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:JEAN
Last Name:RED CORN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:JEAN
Other - Last Name:UBBEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:20930 W 151ST ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-7228
Mailing Address - Country:US
Mailing Address - Phone:913-782-2525
Mailing Address - Fax:913-782-9307
Practice Address - Street 1:20930 W 151ST ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-7228
Practice Address - Country:US
Practice Address - Phone:913-782-2525
Practice Address - Fax:913-782-9307
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-36800208000000X
KS2010018333208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201082670AMedicaid
KS110116028Medicare PIN