Individual
MS. EMILY ELISE KERMICLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
305 W JACKSON ST, SUITE 200, CARBONDALE, IL 62901-1474
(618) 536-6621
(618) 453-1102
Mailing address
305 W JACKSON ST, SUITE 200, CARBONDALE, IL 62901-1474
(618) 536-6621
(618) 453-1102
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085004680
IL
Other
Enumeration date
03/11/2013
Last updated
12/28/2020
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