Provider Demographics
NPI:1104966043
Name:DAVIS, ERICA L (PA)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:L
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:L
Other - Last Name:FINCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2004 N HWY 81
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-1460
Mailing Address - Country:US
Mailing Address - Phone:580-252-1911
Mailing Address - Fax:580-252-1020
Practice Address - Street 1:2004 N HWY 81
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-1460
Practice Address - Country:US
Practice Address - Phone:580-252-1911
Practice Address - Fax:580-252-1020
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKAPA1623363A00000X
OK1623363AS0400X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK317858YVEQMedicare PIN