Provider Demographics
NPI:1346727542
Name:EMERSON, KAYTLIN (PA-C)
Entity Type:Individual
Prefix:
First Name:KAYTLIN
Middle Name:
Last Name:EMERSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13005 SOUTHERN BLVD STE 111
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-9231
Mailing Address - Country:US
Mailing Address - Phone:561-798-2002
Mailing Address - Fax:
Practice Address - Street 1:13005 SOUTHERN BLVD STE 111
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-9231
Practice Address - Country:US
Practice Address - Phone:561-798-2002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-20
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant