Emily Buckmiller Supernova, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA2967 Issued in KY

Practice address

4001 Dutchmans LN
Louisville, KY 40207-4714

Phone

(502) 559-3930

Fax

(502) 559-4605

NPI assigned

Mar 12, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in KY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Norton Childrens Medical Group, LLC

  dba Norton Children's Medical Group

  • Pediatrics Physician
  • Louisville, KY
  • NPI 1326695255

  Physician Assistant

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1520812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783382400000",
    "number": "1194228684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 776879",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606776879",
            "telephone_number": "502-588-9490",
            "fax_number": "502-272-5116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4001 DUTCHMANS LN",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402074714",
            "telephone_number": "502-559-3930",
            "fax_number": "502-559-4605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUPERNOVA",
        "first_name": "EMILY",
        "middle_name": "BUCKMILLER",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-12",
        "last_updated": "2026-07-07",
        "certification_date": "2026-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2018013895",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KY",
            "license": "PA2967",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "10732519-1206",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "PA2967",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John E Sunderland, MD, MS
• Manasa Sunkara
• Sunny Enterprise Inc (westport medical)
• Sunny Enterprises Inc (Westport Medical Equipment & Supplies)
• Superior Van & Mobility, LLC
• Support Recovery Consultants LLC
• Supports for Community Living, LLC
• Hamdi Surakji, MD
• Sure Care Surgical First Assistance, LLC
• Sure-Fit Dentures Inc.

• Physician Assistant in Louisville, KY
• Providers in Louisville, KY by specialty
• Physician Assistant in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.