Basic Information
| Provider Information | |||||||||
| NPI: | 1275560336 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HICKERSON | ||||||||
| FirstName: | ERICA | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | OBORNY | ||||||||
| OtherFirstName: | ERICA | ||||||||
| OtherMiddleName: | CARIN | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | P.A. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 1973 | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672011973 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3167221333 | ||||||||
| FaxNumber: | 3167223058 | ||||||||
| Practice Location | |||||||||
| Address1: | 4013 N RIDGE RD | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672058857 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3167221333 | ||||||||
| FaxNumber: | 3167223058 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2006 | ||||||||
| LastUpdateDate: | 10/11/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 15-01027 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.