Provider Demographics
NPI:1548014988
Name:FARRIS, EMALEE ANN (PA-C)
Entity type:Individual
Prefix:
First Name:EMALEE
Middle Name:ANN
Last Name:FARRIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:EMALEE
Other - Middle Name:ANN
Other - Last Name:COPELAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1841 S 11TH PL
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-5830
Mailing Address - Country:US
Mailing Address - Phone:479-228-3834
Mailing Address - Fax:
Practice Address - Street 1:621 S NEW BALLAS RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8232
Practice Address - Country:US
Practice Address - Phone:314-251-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023049143363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant