Provider Demographics
NPI:1255314159
Name:EMERSON-JOHNSON, TAMMIE L (FNP)
Entity Type:Individual
Prefix:
First Name:TAMMIE
Middle Name:L
Last Name:EMERSON-JOHNSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 54
Mailing Address - Street 2:728 WILBURN ROSS HWY
Mailing Address - City:STEARNS
Mailing Address - State:KY
Mailing Address - Zip Code:42647-0054
Mailing Address - Country:US
Mailing Address - Phone:606-376-9544
Mailing Address - Fax:
Practice Address - Street 1:71 MEDICAL LN
Practice Address - Street 2:
Practice Address - City:WHITLEY CITY
Practice Address - State:KY
Practice Address - Zip Code:42653-4216
Practice Address - Country:US
Practice Address - Phone:606-376-7212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3202P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78004090Medicaid
KY0739605Medicare ID - Type Unspecified
KY78004090Medicaid