Provider Demographics
NPI:1710487236
Name:ERIKSON, KIMBERLY (RN BSN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:ERIKSON
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 PECOS TRL
Mailing Address - Street 2:
Mailing Address - City:CROSSROADS
Mailing Address - State:TX
Mailing Address - Zip Code:76227-2238
Mailing Address - Country:US
Mailing Address - Phone:815-295-0685
Mailing Address - Fax:
Practice Address - Street 1:204 PECOS TRL
Practice Address - Street 2:
Practice Address - City:CROSSROADS
Practice Address - State:TX
Practice Address - Zip Code:76227-2238
Practice Address - Country:US
Practice Address - Phone:815-295-0685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX896191163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse