Provider Demographics
NPI:1205288834
Name:WALSH, EMILY ANNE (PA)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ANNE
Last Name:WALSH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:ANNE
Other - Last Name:MCCUMISKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 727
Mailing Address - Street 2:
Mailing Address - City:HORNELL
Mailing Address - State:NY
Mailing Address - Zip Code:14843-0727
Mailing Address - Country:US
Mailing Address - Phone:607-324-5404
Mailing Address - Fax:607-324-5463
Practice Address - Street 1:191 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:WELLSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14895
Practice Address - Country:US
Practice Address - Phone:585-593-1100
Practice Address - Fax:607-324-5463
Is Sole Proprietor?:No
Enumeration Date:2016-07-07
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY19869363A00000X
NY390200000X
NY019869363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program