Provider Demographics
NPI:1366320665
Name:BOUYEA, EMILY RENEE (PA-C)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:RENEE
Last Name:BOUYEA
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 1:1436 CARUTH LN
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:TX
Mailing Address - Zip Code:75009-3825
Mailing Address - Country:US
Mailing Address - Phone:469-744-2288
Mailing Address - Fax:
Practice Address - Street 1:1061 N COLEMAN ST STE 10
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-2318
Practice Address - Country:US
Practice Address - Phone:469-296-1049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant