Provider Demographics
NPI:1093300873
Name:CAPECCHI, EMILY MICHELLE (PA)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:MICHELLE
Last Name:CAPECCHI
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-362-5298
Mailing Address - Fax:888-824-2176
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:DIV SURG ACCS, STE 12B
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-362-5298
Practice Address - Fax:888-824-2176
Is Sole Proprietor?:No
Enumeration Date:2021-03-04
Last Update Date:2024-04-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2021010577363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO220094855Medicaid