Provider Demographics
NPI:1306227566
Name:HARLESS, EMILY (AGPCNP-C)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:HARLESS
Suffix:
Gender:F
Credentials:AGPCNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 E KIVETT ST
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-6438
Mailing Address - Country:US
Mailing Address - Phone:571-228-8943
Mailing Address - Fax:
Practice Address - Street 1:138 DUBLIN SQUARE RD
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-8600
Practice Address - Country:US
Practice Address - Phone:336-610-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-13
Last Update Date:2015-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5007669363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner