Healthcare Provider Details

I. General information

NPI: 1154653954
Provider Name (Legal Business Name): KATHY LEE ERAZO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2010
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 S THORNTON AVE
PIGGOTT AR
72454-2731
US

IV. Provider business mailing address

PO BOX 301
PIGGOTT AR
72454-0301
US

V. Phone/Fax

Practice location:
  • Phone: 870-970-3180
  • Fax: 870-343-6262
Mailing address:
  • Phone: 870-970-3180
  • Fax: 870-343-6262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number234010
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: