Provider Demographics
NPI:1134510183
Name:EMLY, JESSICA LYNN (CNM)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:EMLY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3200 NORTHLINE AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-7600
Mailing Address - Country:US
Mailing Address - Phone:336-286-6565
Mailing Address - Fax:336-286-6566
Practice Address - Street 1:930 3RD ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-6967
Practice Address - Country:US
Practice Address - Phone:336-890-3200
Practice Address - Fax:336-890-3290
Is Sole Proprietor?:No
Enumeration Date:2015-02-12
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC559176B00000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife