Provider Demographics
NPI:1942667399
Name:PROPST, EMILY VANDERBURG (PA)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:VANDERBURG
Last Name:PROPST
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:VANDERBURG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13460 PLAZA ROAD EXT STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-8923
Practice Address - Country:US
Practice Address - Phone:704-316-4990
Practice Address - Fax:704-316-4998
Is Sole Proprietor?:No
Enumeration Date:2016-01-15
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-06198363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant