Individual
ERICA DANIELLE BLALOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1359 OLD WATER WORKS RD SW, FORT PAYNE, AL 35968-3347
(256) 997-5900
(256) 997-5995
Mailing address
1359 OLD WATER WORKS RD SW, FORT PAYNE, AL 35968-3347
(256) 997-5900
(256) 997-5995
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
1131087
AL
363LF0000X
Family Nurse Practitioner
19028
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-131087
ALABAMA NP/RN LICENSE
AL
05
—
179228
—
AL
Enumeration date
09/08/2014
Last updated
03/31/2017
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