Provider Demographics
NPI:1326555459
Name:EMMONS, KASEY LEIGH (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:KASEY
Middle Name:LEIGH
Last Name:EMMONS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 JACKSON TRACE RD
Mailing Address - Street 2:
Mailing Address - City:WETUMPKA
Mailing Address - State:AL
Mailing Address - Zip Code:36092-1504
Mailing Address - Country:US
Mailing Address - Phone:334-567-2882
Mailing Address - Fax:334-567-3361
Practice Address - Street 1:815 JACKSON TRACE RD
Practice Address - Street 2:
Practice Address - City:WETUMPKA
Practice Address - State:AL
Practice Address - Zip Code:36092
Practice Address - Country:US
Practice Address - Phone:334-567-2882
Practice Address - Fax:334-567-3361
Is Sole Proprietor?:No
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-107949163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse