Provider Demographics
NPI:1508301276
Name:RUTT, EMILY (CPNP-AC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:RUTT
Suffix:
Gender:F
Credentials:CPNP-AC
Other - Prefix:MS
Other - First Name:EMILY
Other - Middle Name:R
Other - Last Name:RUTT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CPNP-AC
Mailing Address - Street 1:262 DANNY THOMAS PL
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-3678
Mailing Address - Country:US
Mailing Address - Phone:901-595-5400
Mailing Address - Fax:901-595-0913
Practice Address - Street 1:262 DANNY THOMAS PL
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-3678
Practice Address - Country:US
Practice Address - Phone:901-595-5400
Practice Address - Fax:901-595-0913
Is Sole Proprietor?:No
Enumeration Date:2017-01-04
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN22137363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics