Healthcare Provider Details

I. General information

NPI: 1730925421
Provider Name (Legal Business Name): ERICKA DAWN SOUTHWICK APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2024
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6895 E HAMPDEN AVE
DENVER CO
80224-3047
US

IV. Provider business mailing address

1100 CARSON AVE
LA JUNTA CO
81050-2751
US

V. Phone/Fax

Practice location:
  • Phone: 303-861-7878
  • Fax: 303-894-8066
Mailing address:
  • Phone: 719-384-5412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN.0999916-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number10058529
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0999916-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: