Healthcare Provider Details

I. General information

NPI: 1518536838
Provider Name (Legal Business Name): TIFFANY EMANUELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2021
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9191 KYSER WAY STE 500
FRISCO TX
75033-1956
US

IV. Provider business mailing address

9191 KYSER WAY STE 500
FRISCO TX
75033-1956
US

V. Phone/Fax

Practice location:
  • Phone: 972-324-3366
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberW4095
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: