Healthcare Provider Details

I. General information

NPI: 1245008887
Provider Name (Legal Business Name): EMMA LOVE TRASK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2023
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12200 PARK CENTRAL DR STE 400
DALLAS TX
75251-2116
US

IV. Provider business mailing address

12200 PARK CENTRAL DR STE 400
DALLAS TX
75251-2116
US

V. Phone/Fax

Practice location:
  • Phone: 214-483-9300
  • Fax: 214-483-9301
Mailing address:
  • Phone: 214-483-9300
  • Fax: 214-483-9301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: