MEDICARE: KIMBERLY ANN ERICKSON

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	207V00000X	Obstetrics & Gynecology Physician	0001220263	VA

General Provider Information

NPI Number	:	1417659749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY ANN ERICKSON

Provider Business Mailing Address
First Line	:	7965 SEQUOIA PARK WAY
Second Line	:
City	:	BRISTOW
State	:	VA
Zip	:	20136-1286
Country	:	US
Telephone Number	:	703-945-0917
Fax Number	:

Provider Business Practice Location Address
First Line	:	7965 SEQUOIA PARK WAY
Second Line	:
City	:	BRISTOW
State	:	VA
Zip	:	20136-1286
Country	:	US
Telephone Number	:	703-945-0917
Fax Number	:

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

Provider Enumeration Date	:	03/20/2023
Last Update Date	:	03/20/2023

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Directions to “ KIMBERLY ANN ERICKSON ” Practice Location

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