Provider Demographics
NPI:1740240910
Name:SMITH, ERIKA NIKOLE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ERIKA
Middle Name:NIKOLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6780 W THUNDERBIRD RD
Mailing Address - Street 2:SUITE A101
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-5049
Mailing Address - Country:US
Mailing Address - Phone:602-843-1991
Mailing Address - Fax:602-843-3224
Practice Address - Street 1:6780 W THUNDERBIRD RD
Practice Address - Street 2:SUITE A101
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-5049
Practice Address - Country:US
Practice Address - Phone:602-843-1991
Practice Address - Fax:602-843-3224
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2944363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ854788Medicaid