Provider Demographics
NPI:1114559804
Name:WARRICK, EMILY BROOKE
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:BROOKE
Last Name:WARRICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2696 GREENSBORO RD
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-8106
Mailing Address - Country:US
Mailing Address - Phone:276-638-7205
Mailing Address - Fax:
Practice Address - Street 1:1329 SANDY RIVER RD
Practice Address - Street 2:
Practice Address - City:AXTON
Practice Address - State:VA
Practice Address - Zip Code:24054-2761
Practice Address - Country:US
Practice Address - Phone:276-340-7027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-10
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110-007720363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant