Provider Demographics
NPI:1952627242
Name:EMERY, CODY VAN (PA-C)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:VAN
Last Name:EMERY
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:300 W CENTRAL TEXAS EXPY
Mailing Address - Street 2:SUITE 115
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-1885
Mailing Address - Country:US
Mailing Address - Phone:254-833-8456
Mailing Address - Fax:254-833-9162
Practice Address - Street 1:3201 UNIVERSITY DR E STE 135
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-3481
Practice Address - Country:US
Practice Address - Phone:979-703-1832
Practice Address - Fax:979-703-1937
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-13
Last Update Date:2018-03-17
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Provider Licenses
StateLicense IDTaxonomies
TXPA06465363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant