Provider Demographics
NPI:1336302470
Name:MYERS, ERICA RENEE (BA)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:RENEE
Last Name:MYERS
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3985 MIDWAY RD
Mailing Address - Street 2:
Mailing Address - City:BRANDENBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40108-9631
Mailing Address - Country:US
Mailing Address - Phone:270-668-3475
Mailing Address - Fax:
Practice Address - Street 1:3985 MIDWAY RD
Practice Address - Street 2:
Practice Address - City:BRANDENBURG
Practice Address - State:KY
Practice Address - Zip Code:40108-9631
Practice Address - Country:US
Practice Address - Phone:270-668-3475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker