Provider Demographics
NPI:1548436553
Name:PHAN, EMILY A (PA-C)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:A
Last Name:PHAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3809 W 15TH ST
Mailing Address - Street 2:BLDG 700-B
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-1601
Mailing Address - Country:US
Mailing Address - Phone:972-596-4005
Mailing Address - Fax:972-985-1253
Practice Address - Street 1:3809 W 15TH ST
Practice Address - Street 2:BLDG 700-B
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-1601
Practice Address - Country:US
Practice Address - Phone:972-596-4005
Practice Address - Fax:972-985-1253
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA05547363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical