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General NPI Number Information
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NPI Number | 1710409883
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Entity Type | Individual
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Provider Name | ERICA ELLIOTT BRUMLEY FNP
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Gender | Female
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Dates
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Enumeration Date | 07/11/2017
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Last Update Date | 11/10/2020
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Provider Practice Location Address
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Address Line | 608 S HIGHWAY 65 82 STE C
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City | LAKE VILLAGE
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State | AR
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Zip | 71653-1744
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Country | US
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Telephone | 870-265-9810
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Fax | 870-265-9813
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Provider Business Mailing Address
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Address Line | PO BOX 849
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City | OAK GROVE
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State | LA
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Zip | 71263-0849
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP09412
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | A005285
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License Number State | AR
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