Provider Demographics
NPI:1255680930
Name:PHIFER MENEFEE, EMILY BLYTHE (PA-C)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:BLYTHE
Last Name:PHIFER MENEFEE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:BLYTHE
Other - Last Name:PHIFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1602 KINGS HWY DEPT OF
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-4128
Mailing Address - Country:US
Mailing Address - Phone:318-626-2269
Mailing Address - Fax:318-675-6145
Practice Address - Street 1:1602 KINGS HWY DEPT OF PEDIATRIC ENDOCRINOLOGY
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-4128
Practice Address - Country:US
Practice Address - Phone:318-626-2269
Practice Address - Fax:318-675-6145
Is Sole Proprietor?:No
Enumeration Date:2012-09-10
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.200556363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2314092Medicaid