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NPI Code Detail

MEDICARE: EMILY FENNING ELMORE PA-C

MEDICARE: EMILY FENNING ELMORE 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
1363A00000XPhysician Assistant0110009101VA

General Provider Information

NPI Number : 1487308870
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMILY FENNING ELMORE PA-C
Provider Business Mailing Address
First Line : 16890 FOREST RD
Second Line :
City : FOREST
State : VA
Zip : 24551-4059
Country : US
Telephone Number : 434-200-7210
Fax Number :
Provider Business Practice Location Address
First Line : 16890 FOREST RD
Second Line :
City : FOREST
State : VA
Zip : 24551-4059
Country : US
Telephone Number : 434-200-7210
Fax Number : 434-525-2138
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2022
Last Update Date : 11/07/2025

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