Provider Demographics
NPI:1588200885
Name:ERICKSON, KATHRYN ANNE (ARNP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ANNE
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:HEMMY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:5338 PLANTATION HOME WAY
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-7529
Mailing Address - Country:US
Mailing Address - Phone:386-333-2235
Mailing Address - Fax:
Practice Address - Street 1:1630 MASON AVE STE C
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-4503
Practice Address - Country:US
Practice Address - Phone:386-238-9064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-21
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAG11005008363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health