| Doctor Name: | KATHY CLYDEAN ERICKSON |
| NPI Number: | 1316921430 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN, CS, FNP |
| License Number: | 065142 |
| Business Practice Address: | 1600 E Evergreen St Suite C Cameron, MO - 644292400 |
| Business Phone Number: | 8166322139 |
| Business Fax Number: | 8166322315 |
| Mailing Address: | 1600 E Evergreen St, Po Box 557 CAMERON |
| State: | MO |
| Postal Code: | 644292400 |
| Phone Number: | 8166322101 |
| Fax Number: | 8166493383 |
| NPI Enumeration Date: | 12/01/2005 |
| NPI Last Update Date: | 12/02/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LG0600X |
| License Number: | 065142 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Gerontology |
| Taxonomy Definition: | |