MEDICARE: CASEY ANN ERICKSON BSN, RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0200X	Pediatric Registered Nurse	1039963	TX

General Provider Information

NPI Number	:	1134057078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASEY ANN ERICKSON BSN, RN

Provider Business Mailing Address
First Line	:	301 CLARIDEN RANCH RD
Second Line	:
City	:	SOUTHLAKE
State	:	TX
Zip	:	76092-1958
Country	:	US
Telephone Number	:	972-897-0345
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 COOPER ST
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76104-2710
Country	:	US
Telephone Number	:	682-885-1514
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2026
Last Update Date	:	05/11/2026

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