Healthcare Provider Details

I. General information

NPI: 1881197325
Provider Name (Legal Business Name): JOEL WILLIAM ERICKSON ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2018
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16004 BRAVADO PL
EDMOND OK
73013-2204
US

IV. Provider business mailing address

16004 BRAVADO PL
EDMOND OK
73013-2204
US

V. Phone/Fax

Practice location:
  • Phone: 405-684-7474
  • Fax:
Mailing address:
  • Phone: 405-684-7474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number110910
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9422590
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9422590
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number110910
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: