Grant, Emilye Jessica

Grant, Emilye Jessica is an individual health care provider with primary practice located at 1750 E Lake Shore Dr , Decatur IL 62521-3803. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Medical, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is her primary health care specialty. Grant, Emilye Jessica can be contacted via phone (217) 464-1750.

Contact Information

Primary practice address
1750 E Lake Shore Dr Decatur IL 62521-3803
Phone: (217) 464-1750
Fax: (217) 464-1469
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X PA30148 District of Columbia
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA200169 Louisiana
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 085005568 Illinois

Profile Details

NPI number 1396721189
LBN Legal business name Grant, Emilye Jessica
Credentials PHYSICIAN ASSISTANT
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 22nd, 2005
Last updated Jul 24th, 2015 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1396721189 NPPES
Louisiana MEDICAID 1027626

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