Healthcare Provider Details

I. General information

NPI: 1649653320
Provider Name (Legal Business Name): ERIN PEARCY P.A.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2015
Last Update Date: 06/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 HOSPITAL DR
RATON NM
87740-2012
US

IV. Provider business mailing address

2977 NICKEL ST
LOS ALAMOS NM
87544-2198
US

V. Phone/Fax

Practice location:
  • Phone: 575-445-3661
  • Fax:
Mailing address:
  • Phone: 505-999-0819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA2015-0040
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: