Provider Demographics
NPI:1225375538
Name:SHUPP, EMMA MERCEDES (FNP)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:MERCEDES
Last Name:SHUPP
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:BLONDY
Other - Middle Name:
Other - Last Name:SHUPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:330 SEVEN SPRINGS WAY
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5098
Mailing Address - Country:US
Mailing Address - Phone:615-920-7000
Mailing Address - Fax:
Practice Address - Street 1:21 1ST ST
Practice Address - Street 2:
Practice Address - City:MONTEAGLE
Practice Address - State:TN
Practice Address - Zip Code:37356
Practice Address - Country:US
Practice Address - Phone:931-924-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-07
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26778363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily