Provider Demographics
NPI:1376264895
Name:BRYCE, EMILY ELLIOTT (PA-C)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ELLIOTT
Last Name:BRYCE
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 1:1824 JACK MARTIN RD
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:LA
Mailing Address - Zip Code:71055-6556
Mailing Address - Country:US
Mailing Address - Phone:318-393-9800
Mailing Address - Fax:
Practice Address - Street 1:1322 KINGS HWY
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-4225
Practice Address - Country:US
Practice Address - Phone:318-626-4335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-05
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA334156363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant