Healthcare Provider Details

I. General information

NPI: 1164996419
Provider Name (Legal Business Name): EMILY TAYLOR FERRERIA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2019
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

870 SEVEN HILLS DR STE 203
HENDERSON NV
89052-4379
US

IV. Provider business mailing address

10466 SMOKEWOOD RD
LAS VEGAS NV
89135-4023
US

V. Phone/Fax

Practice location:
  • Phone: 702-463-4788
  • Fax:
Mailing address:
  • Phone: 661-312-5265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2085
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: