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NPI Code Detail

MEDICARE: MRS. ERICKA DAWN SOUTHWICK APN

MEDICARE: MRS. ERICKA DAWN SOUTHWICK APN
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
1363L00000XNurse PractitionerAPN.0999916-NPCO
2363L00000XNurse Practitioner10058529OR
3363LF0000XFamily Nurse PractitionerAPN.0999916-NPCO

General Provider Information

NPI Number : 1730925421
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ERICKA DAWN SOUTHWICK APN
Provider Business Mailing Address
First Line : 1100 CARSON AVE
Second Line :
City : LA JUNTA
State : CO
Zip : 81050-2751
Country : US
Telephone Number : 719-384-5412
Fax Number :
Provider Business Practice Location Address
First Line : 6895 E HAMPDEN AVE
Second Line :
City : DENVER
State : CO
Zip : 80224-3047
Country : US
Telephone Number : 303-861-7878
Fax Number : 303-894-8066
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/02/2024
Last Update Date : 06/03/2026

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