Provider Demographics
NPI:1215500327
Name:UPCHURCH, ERICA CHRISTINE
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:CHRISTINE
Last Name:UPCHURCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1838 ENSLOW BLVD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-4910
Mailing Address - Country:US
Mailing Address - Phone:740-547-7170
Mailing Address - Fax:
Practice Address - Street 1:1838 ENSLOW BLVD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-4910
Practice Address - Country:US
Practice Address - Phone:740-547-7170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker