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General NPI Number Information
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NPI Number | 1578068177
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Entity Type | Individual
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Provider Name | ERIN MARIE MCCORMICK PA-C
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Gender | Female
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Dates
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Enumeration Date | 03/26/2018
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Last Update Date | 05/19/2022
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Provider Practice Location Address
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Address Line | 2581 HALL JOHNSON RD
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City | GRAPEVINE
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State | TX
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Zip | 76051
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Country | US
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Telephone | --
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Fax |
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Provider Business Mailing Address
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Address Line | 2581 HALL JOHNSON RD APT 227
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City | GRAPEVINE
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State | TX
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Zip | 76051-7188
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Country | US
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Telephone |
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA11855
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License Number State | TX
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