Provider Demographics
NPI:1861719437
Name:PATTON, ERICA DAVIS (FNP-BC)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:DAVIS
Last Name:PATTON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:DAVIS
Other - Last Name:PATTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:504 NORTH MASON ST
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:TX
Mailing Address - Zip Code:76230
Mailing Address - Country:US
Mailing Address - Phone:940-872-3333
Mailing Address - Fax:940-872-2550
Practice Address - Street 1:504 N MASON ST
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:TX
Practice Address - Zip Code:76230-4231
Practice Address - Country:US
Practice Address - Phone:940-872-3333
Practice Address - Fax:940-872-2550
Is Sole Proprietor?:No
Enumeration Date:2010-04-22
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX687899207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX687899OtherLICENSE