Provider Demographics
NPI:1376112631
Name:MCGOUGH, EMILY (FNP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:MCGOUGH
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 730
Mailing Address - Street 2:
Mailing Address - City:OPHIR
Mailing Address - State:CO
Mailing Address - Zip Code:81426-0730
Mailing Address - Country:US
Mailing Address - Phone:970-759-8552
Mailing Address - Fax:
Practice Address - Street 1:TELLURIDE MEDICAL CENTER
Practice Address - Street 2:500 W PACIFIC AVE.
Practice Address - City:TELLURIDE
Practice Address - State:CO
Practice Address - Zip Code:81435
Practice Address - Country:US
Practice Address - Phone:970-728-3848
Practice Address - Fax:970-728-3404
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0996933-NP363LF0000X
CORN.1627941163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily