Provider Demographics
NPI:1225549538
Name:KETZ, EMILY ELIZABETH (PA-C)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ELIZABETH
Last Name:KETZ
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:ELIZABETH
Other - Last Name:KETZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 620
Mailing Address - Street 2:
Mailing Address - City:CHINCHILLA
Mailing Address - State:PA
Mailing Address - Zip Code:18410-0620
Mailing Address - Country:US
Mailing Address - Phone:570-587-7817
Mailing Address - Fax:570-587-7815
Practice Address - Street 1:401 N STATE ST
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-1061
Practice Address - Country:US
Practice Address - Phone:570-587-7817
Practice Address - Fax:570-587-7815
Is Sole Proprietor?:No
Enumeration Date:2017-10-14
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA059435363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical