MEDICARE: MRS. ERICKA NICOLE NORRIS P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	0010-03844	NC
2	363AM0700X	Medical Physician Assistant	0010-03844	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942552674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ERICKA NICOLE NORRIS P.A.

Provider Business Mailing Address
First Line	:	PO BOX 601843
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-1843
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9600 E INDEPENDENCE BLVD
Second Line	:
City	:	MATTHEWS
State	:	NC
Zip	:	28105-4628
Country	:	US
Telephone Number	:	704-815-5624
Fax Number	:	704-815-5621

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2012
Last Update Date	:	10/26/2020

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Directions to “ MRS. ERICKA NICOLE NORRIS P.A.” Practice Location

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