Provider Demographics
NPI:1154658409
Name:HARLESS, EMILY L (FNP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:L
Last Name:HARLESS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2945 MAYNARDVILLE HWY
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MAYNARDVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37807-3251
Mailing Address - Country:US
Mailing Address - Phone:865-745-1258
Mailing Address - Fax:865-745-1276
Practice Address - Street 1:2945 MAYNARDVILLE HWY
Practice Address - Street 2:SUITE 3
Practice Address - City:MAYNARDVILLE
Practice Address - State:TN
Practice Address - Zip Code:37807-3251
Practice Address - Country:US
Practice Address - Phone:865-745-1258
Practice Address - Fax:865-745-1276
Is Sole Proprietor?:No
Enumeration Date:2009-11-06
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN14849363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily