MEDICARE: BECKY EMERSON PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	575	SD
2	363AM0700X	Medical Physician Assistant	575	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184669384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BECKY EMERSON PA-C

Provider Business Mailing Address
First Line	:	1301 S CLIFF AVE
Second Line	:	STE 506
City	:	SIOUX FALLS
State	:	SD
Zip	:	57105-1005
Country	:	US
Telephone Number	:	605-335-0844
Fax Number	:	605-977-1715

Provider Business Practice Location Address
First Line	:	1301 S CLIFF AVE
Second Line	:	SUITE 506
City	:	SIOUX FALLS
State	:	SD
Zip	:	57105-1005
Country	:	US
Telephone Number	:	605-335-0844
Fax Number	:	605-977-1715

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	01/23/2014

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Directions to “ BECKY EMERSON PA-C” Practice Location

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