Provider Demographics
NPI:1881197325
Name:ERICKSON, JOEL WILLIAM (ARNP)
Entity type:Individual
Prefix:MR
First Name:JOEL
Middle Name:WILLIAM
Last Name:ERICKSON
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16004 BRAVADO PL
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-2204
Mailing Address - Country:US
Mailing Address - Phone:405-684-7474
Mailing Address - Fax:
Practice Address - Street 1:16004 BRAVADO PL
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-2204
Practice Address - Country:US
Practice Address - Phone:405-684-7474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-12
Last Update Date:2022-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK110910163W00000X, 367500000X
FLRN9422590163W00000X
FLARNP9422590367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse