Provider Demographics
NPI:1245924075
Name:WILLARS, ERICK BRIAN
Entity type:Individual
Prefix:
First Name:ERICK
Middle Name:BRIAN
Last Name:WILLARS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3610 NEHEMIAH PL
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-0753
Mailing Address - Country:US
Mailing Address - Phone:915-332-7125
Mailing Address - Fax:
Practice Address - Street 1:3610 NEHEMIAH PL
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-0753
Practice Address - Country:US
Practice Address - Phone:915-332-7125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1124591363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health