Healthcare Provider Details

I. General information

NPI: 1831619626
Provider Name (Legal Business Name): ERICA CLANAHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2017
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1523 22ND AVE STE B
MERIDIAN MS
39301-4016
US

IV. Provider business mailing address

965 RIDGE LAKE BLVD STE 315
MEMPHIS TN
38120-9401
US

V. Phone/Fax

Practice location:
  • Phone: 601-703-8450
  • Fax: 601-553-6308
Mailing address:
  • Phone: 877-348-1281
  • Fax: 901-227-3206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number1-112196
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number902002
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: