Provider Demographics
NPI:1083703045
Name:EMBRY, JOELLEN BEARD (NP)
Entity Type:Individual
Prefix:
First Name:JOELLEN
Middle Name:BEARD
Last Name:EMBRY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3370 N HAYDEN RD # 123-215
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6632
Mailing Address - Country:US
Mailing Address - Phone:480-376-2170
Mailing Address - Fax:480-376-2169
Practice Address - Street 1:2204 S DOBSON RD STE 203
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202
Practice Address - Country:US
Practice Address - Phone:480-376-2170
Practice Address - Fax:480-699-0056
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN053123363LA2200X, 363LW0102X
AZAP7036363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAP7036OtherARIZONA STATE BOARD OF NURSING
AZ431130Medicaid