Provider Demographics
NPI:1093309023
Name:EMRICK, GRETCHIN DALE (APRN)
Entity Type:Individual
Prefix:
First Name:GRETCHIN
Middle Name:DALE
Last Name:EMRICK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2265 STATE POND RD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62952-2098
Mailing Address - Country:US
Mailing Address - Phone:618-697-5212
Mailing Address - Fax:
Practice Address - Street 1:2751 THOMAS DR
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-2131
Practice Address - Country:US
Practice Address - Phone:573-334-3486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-20
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.022898363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health