Provider Demographics
NPI:1528511516
Name:EMMONS, CLINTON MATTHEW (PA-C)
Entity type:Individual
Prefix:
First Name:CLINTON
Middle Name:MATTHEW
Last Name:EMMONS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3012 S DURANGO DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-9186
Mailing Address - Country:US
Mailing Address - Phone:702-835-0088
Mailing Address - Fax:702-826-3162
Practice Address - Street 1:3012 S DURANGO DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-9186
Practice Address - Country:US
Practice Address - Phone:702-835-0088
Practice Address - Fax:702-826-3162
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-26
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant