Healthcare Provider Details

I. General information

NPI: 1619294998
Provider Name (Legal Business Name): ERICKA KAY DOMALAKES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2010
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9100 W 74TH ST
MERRIAM KS
66204-4004
US

IV. Provider business mailing address

9100 W 74TH ST
MERRIAM KS
66204-4004
US

V. Phone/Fax

Practice location:
  • Phone: 913-676-2694
  • Fax: 913-676-6859
Mailing address:
  • Phone: 913-676-2694
  • Fax: 913-676-6859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number04-38674
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number04-38674
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: