Healthcare Provider Details

I. General information

NPI: 1932796422
Provider Name (Legal Business Name): ERIKO YUTANI KERN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2020
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9432 KATY FWY # 460
HOUSTON TX
77055-6349
US

IV. Provider business mailing address

8337 CRETAN BLUE LN
LAS VEGAS NV
89128-7470
US

V. Phone/Fax

Practice location:
  • Phone: 832-699-7922
  • Fax: 832-780-5341
Mailing address:
  • Phone: 702-408-5785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA17887
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberPA17887
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: