Provider Demographics
NPI:1386496420
Name:REEDY, EMILY JOAN (PA-C)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:JOAN
Last Name:REEDY
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22595 W RIVER RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE ILE
Mailing Address - State:MI
Mailing Address - Zip Code:48138-1445
Mailing Address - Country:US
Mailing Address - Phone:734-552-5485
Mailing Address - Fax:
Practice Address - Street 1:607 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1205
Practice Address - Country:US
Practice Address - Phone:304-766-9136
Practice Address - Fax:304-766-9139
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-02
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV940363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty