Healthcare Provider Details

I. General information

NPI: 1649864034
Provider Name (Legal Business Name): ERICA RENEE PRESTON APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2021
Last Update Date: 04/03/2023
Certification Date: 04/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1712 N ACCESS RD
CLYDE TX
79510-3352
US

IV. Provider business mailing address

400 W PLUMMER ST
EASTLAND TX
76448-2627
US

V. Phone/Fax

Practice location:
  • Phone: 325-893-4010
  • Fax:
Mailing address:
  • Phone: 254-629-1744
  • Fax: 254-629-3904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1030957
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: