Provider Demographics
NPI:1760480552
Name:PARKER, ERICA NICOLE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:NICOLE
Last Name:PARKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:NICOLE
Other - Last Name:MEADOWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5480 BIG TYLER RD
Mailing Address - Street 2:
Mailing Address - City:CROSS LANES
Mailing Address - State:WV
Mailing Address - Zip Code:25313-1116
Mailing Address - Country:US
Mailing Address - Phone:304-776-2409
Mailing Address - Fax:304-776-2023
Practice Address - Street 1:5480 BIG TYLER RD
Practice Address - Street 2:
Practice Address - City:CROSS LANES
Practice Address - State:WV
Practice Address - Zip Code:25313-1116
Practice Address - Country:US
Practice Address - Phone:304-776-2409
Practice Address - Fax:304-776-2023
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV01141363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV01141OtherWV LICENSC