Basic Information
| Provider Information | |||||||||
| NPI: | 1336233055 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ERICKSON | ||||||||
| FirstName: | KARA | ||||||||
| MiddleName: | |||||||||
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| Credential: | PAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2600 WILSON ST | ||||||||
| Address2: | |||||||||
| City: | MILES CITY | ||||||||
| State: | MT | ||||||||
| PostalCode: | 593015094 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062332600 | ||||||||
| FaxNumber: | 4062332553 | ||||||||
| Practice Location | |||||||||
| Address1: | 2600 WILSON STREET | ||||||||
| Address2: | |||||||||
| City: | MILES CITY | ||||||||
| State: | MT | ||||||||
| PostalCode: | 593015016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062332600 | ||||||||
| FaxNumber: | 4062332763 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 02/25/2014 | ||||||||
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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 | 261 | MT | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 0437427 | 05 | MT | MEDICAID | 261 | 01 | MT | MT STATELIC NUMBER | OTHER | 0437427 | 01 | MT | BCBS PROVIDER NUMBER | OTHER |