Provider Demographics
NPI:1578261996
Name:MALLETT, ERICKA ARLENE (FNP)
Entity Type:Individual
Prefix:
First Name:ERICKA
Middle Name:ARLENE
Last Name:MALLETT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6910 TOM HEBERT RD
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70607-0701
Mailing Address - Country:US
Mailing Address - Phone:337-526-0797
Mailing Address - Fax:
Practice Address - Street 1:4150 NELSON RD STE E4
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-4133
Practice Address - Country:US
Practice Address - Phone:337-564-6722
Practice Address - Fax:337-564-6723
Is Sole Proprietor?:No
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA229064363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily