MEDICARE: MS. ERIN MARIE MCCORMICK PA-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	363A00000X	Physician Assistant	PA11855	TX

General Provider Information

NPI Number	:	1578068177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ERIN MARIE MCCORMICK PA-C

Provider Business Mailing Address
First Line	:	2581 HALL JOHNSON RD APT 227
Second Line	:
City	:	GRAPEVINE
State	:	TX
Zip	:	76051-7188
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2581 HALL JOHNSON RD
Second Line	:
City	:	GRAPEVINE
State	:	TX
Zip	:	76051
Country	:	US
Telephone Number	:	--
Fax Number	:

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

Provider Enumeration Date	:	03/26/2018
Last Update Date	:	05/19/2022

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