Provider Demographics
NPI:1134630379
Name:FREDERICK, ERIN (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:
Last Name:FREDERICK
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 1:740 HOSPITAL DR STE 300
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-4666
Mailing Address - Country:US
Mailing Address - Phone:409-212-8111
Mailing Address - Fax:409-981-1792
Practice Address - Street 1:740 HOSPITAL DR STE 300
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4666
Practice Address - Country:US
Practice Address - Phone:409-212-8111
Practice Address - Fax:409-981-1792
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX802418363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1538103189Medicaid