Provider Demographics
NPI:1174980643
Name:HUNDLEY, EMILY DEGATUR (PA)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:DEGATUR
Last Name:HUNDLEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 KALISTE SALOOM RD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-5783
Mailing Address - Country:US
Mailing Address - Phone:337-988-5646
Mailing Address - Fax:
Practice Address - Street 1:1103 KALISTE SALOOM RD
Practice Address - Street 2:SUITE 304
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-5783
Practice Address - Country:US
Practice Address - Phone:337-988-5646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-28
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.200857363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant