Provider Demographics
NPI:1720422504
Name:WOLFE, EMILY CLAIRE (MSN, APRN, CPNP-PC)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:CLAIRE
Last Name:WOLFE
Suffix:
Gender:F
Credentials:MSN, APRN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 BARBARA JORDAN BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-3077
Mailing Address - Country:US
Mailing Address - Phone:512-628-1830
Mailing Address - Fax:512-628-1831
Practice Address - Street 1:5301B DAVIS LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-3961
Practice Address - Country:US
Practice Address - Phone:512-628-1830
Practice Address - Fax:512-628-1831
Is Sole Proprietor?:No
Enumeration Date:2013-04-23
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP122429363LP0200X
TX756845363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX326476401Medicaid
TX326476402Medicaid
TX326476402Medicaid