Provider Demographics
NPI:1932970506
Name:RODTS, EMMA WEST (PA-C)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:WEST
Last Name:RODTS
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 1:232 WILLIAM DRUMMOND WAY
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-1154
Mailing Address - Country:US
Mailing Address - Phone:910-322-4161
Mailing Address - Fax:
Practice Address - Street 1:10931 RAVEN RIDGE RD STE 115
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-6499
Practice Address - Country:US
Practice Address - Phone:919-676-0202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-12
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-13857363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant