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Individual

ERIK P SOUTHARD

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D-NP

Contact information

Practice address
114 N DIVISION ST, CAYUGA, IN 47928-8230
(765) 492-9042
(765) 492-9048
Mailing address
PO BOX 344, CLINTON, IN 47842-0344
(765) 492-9042
(765) 492-9048

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71001737A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200973170
IN
Enumeration date
08/15/2008
Last updated
07/14/2011
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