Healthcare Provider Details

I. General information

NPI: 1447915608
Provider Name (Legal Business Name): EMILY ELISE CARMODY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2021
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 C ST BLDG 990
YUMA AZ
85365-9484
US

IV. Provider business mailing address

301 C ST BLDG 990
YUMA AZ
85365-9484
US

V. Phone/Fax

Practice location:
  • Phone: 928-328-2666
  • Fax: 928-328-3838
Mailing address:
  • Phone: 928-328-2666
  • Fax: 928-328-3838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: