Provider Demographics
NPI:1295887909
Name:EMERSON, ANNE CLOUGHERTY (PA-C)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:CLOUGHERTY
Last Name:EMERSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:MICHELLE
Other - Last Name:CLOUGHERTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 25608
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84125-0608
Mailing Address - Country:US
Mailing Address - Phone:206-320-4476
Mailing Address - Fax:206-568-7043
Practice Address - Street 1:7210 ROOSEVELT WAY NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-5600
Practice Address - Country:US
Practice Address - Phone:206-320-3400
Practice Address - Fax:206-320-5773
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004693363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8405862Medicaid
WA8850398OtherMEDICARE
WAQ31539Medicare UPIN