Provider Demographics
NPI:1700640679
Name:YOUNGBLOOD, EMILY ANNE (PA-C)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ANNE
Last Name:YOUNGBLOOD
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 1:1300 CENTERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4349
Mailing Address - Country:US
Mailing Address - Phone:501-219-8900
Mailing Address - Fax:501-410-1148
Practice Address - Street 1:1300 CENTERVIEW DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-4349
Practice Address - Country:US
Practice Address - Phone:501-219-8900
Practice Address - Fax:501-410-1148
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT2024-023363A00000X
ARPA-1257363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant