Provider Demographics
NPI:1295764975
Name:WICKS, ERIKA H (PA-C)
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:H
Last Name:WICKS
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 1:2695 ROCKY MOUNTAIN AVE
Mailing Address - Street 2:STE 150
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-8702
Mailing Address - Country:US
Mailing Address - Phone:970-297-6250
Mailing Address - Fax:970-297-6260
Practice Address - Street 1:2127 E HARMONY RD
Practice Address - Street 2:STE 140
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-3405
Practice Address - Country:US
Practice Address - Phone:970-297-6250
Practice Address - Fax:970-297-6260
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0001957363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO68321848Medicaid
COCOA106439Medicare PIN
C57385Medicare UPIN
COCOA106439Medicare PIN