Healthcare Provider Details

I. General information

NPI: 1811794431
Provider Name (Legal Business Name): ERICA CANTERBURY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS ERICA PAULINE LOPEZ

II. Dates (important events)

Enumeration Date: 03/01/2025
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W FRONTIER PKWY STE 125
PROSPER TX
75078-4293
US

IV. Provider business mailing address

500 W FRONTIER PKWY STE 125
PROSPER TX
75078-4293
US

V. Phone/Fax

Practice location:
  • Phone: 469-389-1520
  • Fax: 949-835-7229
Mailing address:
  • Phone: 469-389-1520
  • Fax: 949-835-7229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1057398
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: