Provider Demographics
NPI:1265632178
Name:EMISON, TRENY K (CPNP)
Entity Type:Individual
Prefix:
First Name:TRENY
Middle Name:K
Last Name:EMISON
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:499 GLOSTER CREEK VLG STE H3
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-4661
Mailing Address - Country:US
Mailing Address - Phone:662-840-6026
Mailing Address - Fax:662-840-6030
Practice Address - Street 1:499 GLOSTER CREEK VLG STE H3
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4661
Practice Address - Country:US
Practice Address - Phone:662-840-6026
Practice Address - Fax:662-840-6030
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR743578363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04354767Medicaid