NPIMap

Individual provider Active NPI

Erin Kristin Clikeman, PA-C

  • Physician Assistant
  • Gillette, WY
National Provider Identifier
1720417975
Registry record updated Sep 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA631 Issued in WY
Practice address
100 Warren Ave
Gillette, WY 82716-3728
Phone
(307) 682-2034
Fax
(307) 682-2968
NPI assigned
Nov 8, 2013
Last updated
Sep 27, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA631 WY Primary

Addresses

Primary practice location

100 Warren Ave
Gillette, WY 82716-3728

Mailing address

100 Warren Ave
Gillette, WY 82716-3728
Phone (307) 682-2034

Other names 1

  • Erin Kristin Clark Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250225003864 SD Practitioner - Physician Assistant 7719115708

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

PO Box
Sioux Falls, SD 57118-6370

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Bachelor of Arts, Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Avera McKennan CurrentSince Feb 3, 2025 Accepting new patients
Avera McKennan CurrentSince Feb 3, 2025 Accepting new patients
Avera McKennan Physician Assistant Past Accepting new patients
University Healthcare Physicians, Inc. Physician Assistant Past Accepting new patients

Locations

4400 W 69th St
Ste 1500
Sioux Falls, SD 57108
Phone (605) 322-5700

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 23

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 23

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1383868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695772800000",
    "number": "1720417975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 WARREN AVE",
            "city": "GILLETTE",
            "state": "WY",
            "postal_code": "827163728",
            "telephone_number": "307-682-2034",
            "fax_number": "307-682-2968"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 WARREN AVE",
            "city": "GILLETTE",
            "state": "WY",
            "postal_code": "827163728",
            "telephone_number": "307-682-2034",
            "fax_number": "307-682-2968"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLIKEMAN",
        "first_name": "ERIN",
        "middle_name": "KRISTIN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-11-08",
        "last_updated": "2023-09-27",
        "certification_date": "2023-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WY",
            "license": "PA631",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ERIN",
            "last_name": "CLARK",
            "middle_name": "KRISTIN",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Gillette, WY

Sources for this page

Verify at the official NPI Registry.