Provider Demographics
NPI:1720417975
Name:CLIKEMAN, ERIN KRISTIN (PA-C)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:KRISTIN
Last Name:CLIKEMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:KRISTIN
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:100 WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716-3728
Mailing Address - Country:US
Mailing Address - Phone:307-682-2034
Mailing Address - Fax:307-682-2968
Practice Address - Street 1:100 WARREN AVE
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-3728
Practice Address - Country:US
Practice Address - Phone:307-682-2034
Practice Address - Fax:307-682-2968
Is Sole Proprietor?:No
Enumeration Date:2013-11-08
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPA631363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant