Provider Demographics
NPI:1407257231
Name:BLACK, EMILY KAY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:KAY
Last Name:BLACK
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 1:706 W CENTER ST
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75116-4568
Mailing Address - Country:US
Mailing Address - Phone:972-780-0707
Mailing Address - Fax:
Practice Address - Street 1:706 W CENTER ST
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-4568
Practice Address - Country:US
Practice Address - Phone:972-780-0707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical