Provider Demographics
NPI:1659864445
Name:ROUSE, ERICA LYNN
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:LYNN
Last Name:ROUSE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ERICA
Other - Middle Name:LYNN
Other - Last Name:SCHOLL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN, FNP-BC
Mailing Address - Street 1:PO BOX 801143
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-1143
Mailing Address - Country:US
Mailing Address - Phone:573-331-5583
Mailing Address - Fax:573-331-5079
Practice Address - Street 1:150 S MOUNT AUBURN RD STE 420
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-4911
Practice Address - Country:US
Practice Address - Phone:573-335-4448
Practice Address - Fax:573-335-4466
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015006212363LF0000X
MO2018025778363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420056941Medicaid