MEDICARE: EMILY COYNE PA

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	5601011154	MI

General Provider Information

NPI Number	:	1386383735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY COYNE PA

Provider Business Mailing Address
First Line	:	505 N CLIPPERT ST
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48912-4701
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	935 CHARLEVOIX DR STE 200
Second Line	:
City	:	GRAND LEDGE
State	:	MI
Zip	:	48837-2293
Country	:	US
Telephone Number	:	517-913-4043
Fax Number	:	517-913-4042

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

Provider Enumeration Date	:	06/02/2022
Last Update Date	:	09/26/2025

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Directions to “ EMILY COYNE PA” Practice Location

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