Kathy Clydean Erickson, RN, CS, FNP
Individual provider Active NPI Family Nurse Practitioner · Cameron, MO
NPI 1316921430 · NPPES record last updated Dec 2, 2010
Key facts
- NPI
- 1316921430
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 065142 (MO)
- Practice address
- 1600 E Evergreen St
Suite C
Cameron, MO 64429-2400 - Phone
- (816) 632-2139
- Fax
- (816) 632-2315
- NPI assigned
- Dec 1, 2005
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner, Registered Nurse
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 065142 | MO | Yes |
| Gerontology Nurse Practitioner | 363LG0600X | 065142 | MO |
Addresses
Primary practice location
1600 E Evergreen St
Suite C
Cameron, MO 64429-2400
Mailing address
1600 E Evergreen St
PO Box 557
Cameron, MO 64429-2400
Phone (816) 632-2101
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 427786421 | Medicaid | MO | |
| P00607932 | Other | MO | MEDICARE RAILROAD |
Other providers in Cameron, MO
- Emily Paige Doty
- Douglas a Wyckoff DDS PC
- Dva Renal Healthcare Inc
- Sheri Lynn Ealey
- Elizabeth E Eickman
- Family Foot Healthcare LLC
- Kathleen Bryn Fitzmaurice
- Joshua Wayne Ford
- Cassandra Katherine Anne From
- Ronald David Gabbart
All providers in Cameron, MO · Family Nurse Practitioner in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 2, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.