Provider Demographics
NPI:1710409883
Name:BRUMLEY, ERICA ELLIOTT (FNP)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:ELLIOTT
Last Name:BRUMLEY
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:PO BOX 849
Mailing Address - Street 2:
Mailing Address - City:OAK GROVE
Mailing Address - State:LA
Mailing Address - Zip Code:71263-0849
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:608 S HIGHWAY 65 82 STE C
Practice Address - Street 2:
Practice Address - City:LAKE VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:71653-1744
Practice Address - Country:US
Practice Address - Phone:870-265-9810
Practice Address - Fax:870-265-9813
Is Sole Proprietor?:No
Enumeration Date:2017-07-11
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09412363LF0000X
ARA005285363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARA005285OtherCERTIFIED NURSE PRACTIONER