MEDICARE: ERICK KLEIN NP-C

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	363LF0000X	Family Nurse Practitioner	AP130729	TX

General Provider Information

NPI Number	:	1225483241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICK KLEIN NP-C

Provider Business Mailing Address
First Line	:	101 LAKE SHORE PL
Second Line	:
City	:	JOSHUA
State	:	TX
Zip	:	76058-6107
Country	:	US
Telephone Number	:	817-944-5890
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 LAKE SHORE PL
Second Line	:
City	:	JOSHUA
State	:	TX
Zip	:	76058-6107
Country	:	US
Telephone Number	:	817-944-5890
Fax Number	:

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

Provider Enumeration Date	:	04/27/2016
Last Update Date	:	04/27/2016

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