Provider Demographics
NPI:1316306343
Name:HAIGLER, ERICA
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:HAIGLER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ERICA
Other - Middle Name:NICOLE
Other - Last Name:HAIGLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9123 CROSS PARK DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4552
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9123 CROSS PARK DR
Practice Address - Street 2:SUITE 250
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4552
Practice Address - Country:US
Practice Address - Phone:865-309-5910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-18
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQO17979Medicaid