Provider Demographics
NPI:1922751098
Name:CLOUGH, ERICA KATHRYN (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:KATHRYN
Last Name:CLOUGH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SW LEWIS CT
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64081-4127
Mailing Address - Country:US
Mailing Address - Phone:816-529-4211
Mailing Address - Fax:
Practice Address - Street 1:200 SW LEWIS CT
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64081-4127
Practice Address - Country:US
Practice Address - Phone:816-529-4211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-30
Last Update Date:2022-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021044286363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty