Provider Demographics
NPI:1497368153
Name:BOSTIC, EMILY CHRISTINE (PA-C)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:CHRISTINE
Last Name:BOSTIC
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 1:4009 W MARY JO PL APT 118
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-3518
Mailing Address - Country:US
Mailing Address - Phone:605-661-4530
Mailing Address - Fax:
Practice Address - Street 1:512 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:SD
Practice Address - Zip Code:57014-2225
Practice Address - Country:US
Practice Address - Phone:605-563-2411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant