Healthcare Provider Details

I. General information

NPI: 1386496420
Provider Name (Legal Business Name): EMILY JOAN REEDY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2024
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 SCOTT AVE STE 100
MORGANTOWN WV
26508-8847
US

IV. Provider business mailing address

PO BOX 746768
ATLANTA GA
30374-6768
US

V. Phone/Fax

Practice location:
  • Phone: 304-554-0400
  • Fax:
Mailing address:
  • Phone: 715-531-5650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number940
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: