Provider Demographics
NPI:1154509628
Name:EMBRY, JAMES W (NP)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:W
Last Name:EMBRY
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4402 E ALOHA DR STE 16
Mailing Address - Street 2:
Mailing Address - City:DIAMONDHEAD
Mailing Address - State:MS
Mailing Address - Zip Code:39525-3305
Mailing Address - Country:US
Mailing Address - Phone:228-364-9001
Mailing Address - Fax:228-364-9004
Practice Address - Street 1:4402 E ALOHA DR STE 16
Practice Address - Street 2:
Practice Address - City:DIAMONDHEAD
Practice Address - State:MS
Practice Address - Zip Code:39525-3305
Practice Address - Country:US
Practice Address - Phone:228-364-9001
Practice Address - Fax:228-364-9004
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP05425363L00000X
MSR881886363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03383302Medicaid
MS03383302Medicaid