Healthcare Provider Details

I. General information

NPI: 1366145369
Provider Name (Legal Business Name): ERICA LEA WHITSON APRN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W LAUREL ST
INDEPENDENCE KS
67301-3211
US

IV. Provider business mailing address

1300 RAINBOW DR
INDEPENDENCE KS
67301-1557
US

V. Phone/Fax

Practice location:
  • Phone: 620-332-3280
  • Fax: 620-332-3281
Mailing address:
  • Phone: 620-714-1650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number77335
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberTMP-161520
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: