Provider Demographics
NPI:1285055657
Name:JUSSEAUME, EMMA CECILIA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:EMMA
Middle Name:CECILIA
Last Name:JUSSEAUME
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1698 HIGHWAY 160 W
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8032
Mailing Address - Country:US
Mailing Address - Phone:803-547-4343
Mailing Address - Fax:803-547-3914
Practice Address - Street 1:1698 HIGHWAY 160 W
Practice Address - Street 2:SUITE 200
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-8032
Practice Address - Country:US
Practice Address - Phone:803-547-4343
Practice Address - Fax:803-547-3914
Is Sole Proprietor?:No
Enumeration Date:2014-01-02
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SCTL2023363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical