Provider Demographics
NPI:1225092810
Name:EMERSON, AMY NISBETT (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:NISBETT
Last Name:EMERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:LAURA
Other - Last Name:NISBETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EMERSON
Mailing Address - Street 1:PO BOX 268838
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-8838
Mailing Address - Country:US
Mailing Address - Phone:918-660-3632
Mailing Address - Fax:918-660-3631
Practice Address - Street 1:4444 E 41ST ST
Practice Address - Street 2:2ND FLOOR, STE. A
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2527
Practice Address - Country:US
Practice Address - Phone:918-619-4300
Practice Address - Fax:918-619-4322
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24003208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics