Healthcare Provider Details

I. General information

NPI: 1225662125
Provider Name (Legal Business Name): ERIN NOVAK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2020
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 N STOCKTON HILL RD
KINGMAN AZ
86401-4667
US

IV. Provider business mailing address

9097 W POST RD STE 100
LAS VEGAS NV
89148-2417
US

V. Phone/Fax

Practice location:
  • Phone: 928-753-9629
  • Fax:
Mailing address:
  • Phone: 702-430-5333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number8940
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License NumberPA2273
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: