Individual
EMILYE JESSICA GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
1750 E LAKE SHORE DR, DECATUR, IL 62521-3803
(217) 464-1750
(217) 464-1469
Mailing address
1750 E LAKE SHORE DR, DECATUR, IL 62521-3803
(217) 464-1750
(217) 464-1469
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085005568
IL
363A00000X
Physician Assistant
PA200169
LA
363AM0700X
Medical Physician Assistant
PA30148
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1027626
—
LA
Enumeration date
12/22/2005
Last updated
10/21/2025
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