Provider Demographics
NPI:1225216153
Name:LUEVANOS, EMILY JACKSON (PA)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:JACKSON
Last Name:LUEVANOS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6124 W PARKER RD
Mailing Address - Street 2:STE 138
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8122
Mailing Address - Country:US
Mailing Address - Phone:972-981-7000
Mailing Address - Fax:972-981-7001
Practice Address - Street 1:6124 W PARKER RD
Practice Address - Street 2:STE 138
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8122
Practice Address - Country:US
Practice Address - Phone:972-981-7000
Practice Address - Fax:972-981-7001
Is Sole Proprietor?:No
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02005363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical