Provider Demographics
NPI:1326764671
Name:RESILIENT EMERALD
Entity Type:Organization
Organization Name:RESILIENT EMERALD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:FRANCIS LEE
Authorized Official - Last Name:PULIKAL
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:417-229-1042
Mailing Address - Street 1:511 OAKWOOD BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-4068
Mailing Address - Country:US
Mailing Address - Phone:417-229-1042
Mailing Address - Fax:
Practice Address - Street 1:511 OAKWOOD BLVD STE 200
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4068
Practice Address - Country:US
Practice Address - Phone:417-229-1042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty