Provider Demographics
NPI:1194486886
Name:DESBIENS, EMILY (PA)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:DESBIENS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10004 KENNERLY RD STE 295B
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2177
Mailing Address - Country:US
Mailing Address - Phone:314-500-2424
Mailing Address - Fax:877-569-3007
Practice Address - Street 1:10004 KENNERLY RD STE 295B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2177
Practice Address - Country:US
Practice Address - Phone:314-500-2424
Practice Address - Fax:877-569-3007
Is Sole Proprietor?:No
Enumeration Date:2022-01-04
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
363A00000X, 363AS0400X
MO2023009785363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical