Provider Demographics
NPI:1821371014
Name:PELINSKI, ERICA JANE (PA - C)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:JANE
Last Name:PELINSKI
Suffix:
Gender:F
Credentials:PA - C
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:JANE
Other - Last Name:PASZKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:54 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:OSAGE BEACH
Mailing Address - State:MO
Mailing Address - Zip Code:65065-3050
Mailing Address - Country:US
Mailing Address - Phone:573-302-3990
Mailing Address - Fax:573-302-2753
Practice Address - Street 1:128 E COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:MO
Practice Address - Zip Code:65536-3257
Practice Address - Country:US
Practice Address - Phone:573-302-3990
Practice Address - Fax:573-302-2753
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021042544363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1618PAMedicaid
NC1821371014Medicaid
MO22012848Medicaid
NCNC4175CMedicare PIN
SC1618PAMedicaid