Healthcare Provider Details

I. General information

NPI: 1447744362
Provider Name (Legal Business Name): EMMA JOHNSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2018
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W HUTCHINGS ST
WINTERSET IA
50273-2109
US

IV. Provider business mailing address

2852 300TH ST
ORIENT IA
50858-8063
US

V. Phone/Fax

Practice location:
  • Phone: 515-462-2950
  • Fax:
Mailing address:
  • Phone: 641-344-5713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number092432
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: