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General NPI Number Information
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NPI Number | 1366733164
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Entity Type | Individual
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Provider Name | ERICA GLOVER FNP
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Gender | Female
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Dates
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Enumeration Date | 04/27/2011
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Last Update Date | 08/30/2020
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Provider Practice Location Address
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Address Line | 10641 HIGHWAY 80 W
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City | MERIDIAN
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State | MS
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Zip | 39307-9256
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Country | US
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Telephone | 601-485-5255
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3452
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City | MERIDIAN
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State | MS
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Zip | 39303-3452
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Country | US
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Telephone | 601-616-7653
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Fax | 601-207-7691
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | R856415
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License Number State | MS
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