Provider Demographics
NPI:1972771020
Name:WILLIAMS, EMILY ELIZABETH (PA-C)
Entity type:Individual
Prefix:MS
First Name:EMILY
Middle Name:ELIZABETH
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:ELIZABETH
Other - Last Name:MALLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2162 W KIMBERLY RD
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52806-5368
Mailing Address - Country:US
Mailing Address - Phone:563-388-7000
Mailing Address - Fax:
Practice Address - Street 1:1903 PARK AVE # 1500
Practice Address - Street 2:
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-5400
Practice Address - Country:US
Practice Address - Phone:563-263-1903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001836363A00000X, 363AM0700X
IL085003198363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA16-1801OtherMEDICARE UGS GROUP #
1932193224OtherCLINIC NPI
IA1932193224Medicaid
IA13238OtherWELLMARK BCBS OF IA
IA161935OtherHEALTH ALLIANCE
IA1972771020OtherBC/BS OF IOWA INDIVIDUAL
IL8122859OtherBCBS OF ILLINOIS
IL421060724002Medicaid
IL1972771020Medicaid
1932193224OtherCLINIC NPI
IL8122859OtherBCBS OF ILLINOIS
IL1972771020Medicaid