Healthcare Provider Details

I. General information

NPI: 1871218065
Provider Name (Legal Business Name): EMILY ROSE FERNANDEZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2022
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4920 CHURCH ST STE E
ZACHARY LA
70791-3580
US

IV. Provider business mailing address

8080 BLUEBONNET BLVD STE 1000
BATON ROUGE LA
70810-7827
US

V. Phone/Fax

Practice location:
  • Phone: 225-658-1808
  • Fax: 225-658-5922
Mailing address:
  • Phone: 225-924-2424
  • Fax: 225-208-2656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number341571
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number341571
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: