Provider Demographics
NPI:1043283252
Name:HIMES, ERIN M (PAC)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:M
Last Name:HIMES
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:M
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:PO BOX 550
Mailing Address - Street 2:
Mailing Address - City:VANCEBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41179-0550
Mailing Address - Country:US
Mailing Address - Phone:606-796-3029
Mailing Address - Fax:606-796-6221
Practice Address - Street 1:17521 W KY 9
Practice Address - Street 2:
Practice Address - City:TOLLESBORO
Practice Address - State:KY
Practice Address - Zip Code:41189-9711
Practice Address - Country:US
Practice Address - Phone:606-798-3151
Practice Address - Fax:606-798-2222
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA850363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY95005682Medicaid
KY95005682Medicaid
KY0055640Medicare PIN