Provider Demographics
NPI:1346951811
Name:FITZSIMMONS, ERIKA GALLARDO (PA-C)
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:GALLARDO
Last Name:FITZSIMMONS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ERIKA
Other - Middle Name:TAYLOR
Other - Last Name:GALLARDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6824 NW CRESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-1015
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6744 NW CACHE RD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-2702
Practice Address - Country:US
Practice Address - Phone:580-536-9355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-06
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0007680363A00000X
OK5210363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant