Provider Demographics
NPI:1407008394
Name:STULTS, EMILY ANNE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:ANNE
Last Name:STULTS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MISS
Other - First Name:EMILY
Other - Middle Name:ANNE
Other - Last Name:O'BRIEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:24812 COUNTY ROAD 4
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-9387
Mailing Address - Country:US
Mailing Address - Phone:574-320-1483
Mailing Address - Fax:
Practice Address - Street 1:7440 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46278-1720
Practice Address - Country:US
Practice Address - Phone:574-320-1483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-22
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28154517A363LF0000X
IN71002789A363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
INF0908063OtherNURSE PRACTITIONER CERTIFICATION NUMBER
INF0908063OtherNURSE PRACTITIONER CERTIFICATION NUMBER