Provider Demographics
NPI:1538889159
Name:WILLOUGHBY, EMMA (NP)
Entity type:Individual
Prefix:MRS
First Name:EMMA
Middle Name:
Last Name:WILLOUGHBY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:
Other - Last Name:COVINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:21807 N SCOTTSDALE RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-7439
Mailing Address - Country:US
Mailing Address - Phone:480-860-8488
Mailing Address - Fax:480-860-8498
Practice Address - Street 1:26224 N TATUM BLVD STE 1
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-7500
Practice Address - Country:US
Practice Address - Phone:480-563-1111
Practice Address - Fax:480-563-3044
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-01
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ222627163W00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ173341Medicaid