Provider Demographics
NPI:1023755055
Name:GRABER, ERIKA NICOLE (PA-C)
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:NICOLE
Last Name:GRABER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12230 BROOKMEADOW LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-1308
Mailing Address - Country:US
Mailing Address - Phone:469-396-6628
Mailing Address - Fax:
Practice Address - Street 1:3155 S CARRIER PKWY
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-6050
Practice Address - Country:US
Practice Address - Phone:972-263-5064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA15676363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant