Provider Demographics
NPI:1639568066
Name:KANG, ERIKA (FNP-C, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:
Last Name:KANG
Suffix:
Gender:F
Credentials:FNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5965 PARKWAY NORTH BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-1431
Mailing Address - Country:US
Mailing Address - Phone:770-886-5700
Mailing Address - Fax:770-886-0404
Practice Address - Street 1:5965 PARKWAY NORTH BLVD STE C
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-1431
Practice Address - Country:US
Practice Address - Phone:770-886-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-22
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN183709363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily