Provider Demographics
NPI:1356596647
Name:CROUSE, ERICA LYNN (RPA-C)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:LYNN
Last Name:CROUSE
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:LYNN
Other - Last Name:KERSHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1226
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37065-1226
Mailing Address - Country:US
Mailing Address - Phone:615-503-9000
Mailing Address - Fax:
Practice Address - Street 1:2508 WARD BLVD
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-1600
Practice Address - Country:US
Practice Address - Phone:252-206-0693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-01
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-01815363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNC6230CMedicare PIN
NCNC6230D540Medicare PIN