Provider Demographics
NPI:1942552674
Name:NORRIS, ERICKA NICOLE (PA)
Entity Type:Individual
Prefix:MRS
First Name:ERICKA
Middle Name:NICOLE
Last Name:NORRIS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ERICKA
Other - Middle Name:NICOLE
Other - Last Name:FAGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 601843
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1843
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9600 E INDEPENDENCE BLVD
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-4628
Practice Address - Country:US
Practice Address - Phone:704-815-5624
Practice Address - Fax:704-815-5621
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-03844363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8102884Medicaid
NC1942552674Medicaid
NCNC9715DMedicare PIN
NCNC97150386Medicare PIN
NCNC9715GMedicare PIN
NCNC9715EMedicare PIN
NC8102884Medicaid
NCNC9715CMedicare PIN