Provider Demographics
NPI:1336536739
Name:BOUNDS, EMILY JO (MD)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:JO
Last Name:BOUNDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:JO
Other - Last Name:DERFELT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 S SANTA FE AVE
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-4144
Mailing Address - Country:US
Mailing Address - Phone:785-452-7163
Mailing Address - Fax:785-452-6873
Practice Address - Street 1:400 S SANTA FE AVE
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-4144
Practice Address - Country:US
Practice Address - Phone:785-452-7163
Practice Address - Fax:785-452-6873
Is Sole Proprietor?:No
Enumeration Date:2015-04-23
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-41010207P00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS2012039708Medicaid
KS100417970BMedicaid